Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida.
Department of Medicine, Mount Sinai Medical Center, Miami Beach, Florida.
J Am Coll Cardiol. 2017 Apr 4;69(13):1694-1703. doi: 10.1016/j.jacc.2017.01.037.
Current electrocardiographic (ECG) criteria for the diagnosis of left ventricular hypertrophy (LVH) have low sensitivity.
The goal of this study was to test a new method to improve the diagnostic performance of the electrocardiogram.
The study was divided into 2 groups, a test and a validation cohort. In the test cohort, 94 patients were analyzed, including 47 with the diagnosis of hypertensive crisis and 47 with normal blood pressure at admission. Echocardiography was used to estimate the left ventricular mass index. Area under the curve (AUC) analysis was used for comparison of single and combined leads. The McNemar test was used to assess agreement among the ECG criteria against the left ventricular mass index. The proposed ECG criteria involved measuring the amplitude of the deepest S wave (S) in any single lead and adding it to the S wave amplitude of lead V (SV). Currently accepted LVH ECG criteria such as Cornell voltage and Sokolow-Lyon were used for comparison. The validation cohort consisted of 122 consecutive patients referred for an echocardiogram regardless of the admitting diagnosis.
The S was the most accurate single lead measurement for the diagnosis of LVH (AUC: 0.80; p < 0.001). When both cohorts were analyzed, the S + SV criteria outperformed Cornell voltage with a significantly higher sensitivity (62% [95% confidence interval [CI]: 50% to 72%] vs. 35% [95% CI: 24% to 46%]). The specificities of all the criteria were ≥90%, with no significant difference among them.
The proposed criteria for the ECG diagnosis of LVH improved the sensitivity and overall accuracy of the test.
目前用于诊断左心室肥厚（LVH）的心电图（ECG）标准敏感性较低。
本研究旨在测试一种新方法以提高心电图的诊断性能。
该研究分为两组，即测试组和验证组。在测试组中，分析了 94 例患者，其中 47 例诊断为高血压危象，47 例入院时血压正常。超声心动图用于估计左心室质量指数。曲线下面积（AUC）分析用于比较单导联和联合导联。McNemar 检验用于评估心电图标准与左心室质量指数之间的一致性。提出的心电图标准涉及测量任何单个导联中最深 S 波（S）的幅度，并将其与导联 V 的 S 波幅度（SV）相加。目前使用的 LVH 心电图标准，如 Cornell 电压和 Sokolow-Lyon，用于比较。验证组由 122 例连续患者组成，无论入院诊断如何，均进行超声心动图检查。
S 波是诊断 LVH 的最准确的单导联测量指标（AUC：0.80；p<0.001）。当分析两个队列时，S+SV 标准的敏感性明显高于 Cornell 电压（62%[95%置信区间（CI）：50%至 72%]比 35%[95%CI：24%至 46%]）。所有标准的特异性均≥90%，无显著差异。
本研究提出的心电图诊断 LVH 的标准提高了检测的敏感性和整体准确性。
