Nath A, Alpert M A, Terry B E, Kelly D L
Department of Medicine, University of Missouri Health Sciences Center, Columbia 65212.
Am J Cardiol. 1988 Jul 1;62(1):126-30. doi: 10.1016/0002-9149(88)91377-x.
To determine the sensitivity and specificity of standard electrocardiographic criteria for left ventricular (LV) and right ventricular (RV) hypertrophy in morbid obesity, resting electrocardiograms and M-mode echocardiograms were obtained in 65 patients whose actual body weight was more than twice their ideal body weight and who were free from hypertension and organic heart disease not directly attributable to obesity. Electrocardiographic criteria for LV hypertrophy were tested using increased LV wall thickness, LV enlargement and increased LV mass (all determined echocardiographically) as diagnostic standards. Electrocardiographic criteria for RV hypertrophy were tested using echocardiographic RV enlargement or RV hypertrophy as a diagnostic standard. Sensitivity values for the electrocardiographic criteria for LV hypertrophy ranged from 0 to 13%, 0 to 20% and 0 to 12% using echocardiographic increased LV wall thickness, LV enlargement and increased LV mass, respectively, as diagnostic standards. Specificity values ranged from 73 to 100%, 87 to 100% and 83 to 100%, respectively, using these diagnostic standards. Sensitivity values for the electrocardiographic criteria for RV hypertrophy ranged from 0 to 16% and specificity values ranged from 95 to 100%. Combining electrocardiographic criteria within groups did not appreciably increase sensitivity and often decreased specificity to unacceptably low levels. The electrocardiogram is very limited in its ability to detect ventricular hypertrophy and chamber enlargement in morbidly obese patients.
为确定标准心电图标准对病态肥胖患者左心室（LV）和右心室（RV）肥厚的敏感性和特异性，对65例实际体重超过理想体重两倍且无高血压及非肥胖直接所致器质性心脏病的患者进行了静息心电图和M型超声心动图检查。以超声心动图测定的左心室壁增厚、左心室扩大和左心室质量增加（均通过超声心动图确定）作为诊断标准，对左心室肥厚的心电图标准进行了检测。以超声心动图显示的右心室扩大或右心室肥厚作为诊断标准，对右心室肥厚的心电图标准进行了检测。以超声心动图显示的左心室壁增厚、左心室扩大和左心室质量增加分别作为诊断标准时，左心室肥厚心电图标准的敏感性值分别为0%至13%、0%至20%和0%至12%。使用这些诊断标准时，特异性值分别为73%至100%、87%至100%和83%至100%。右心室肥厚心电图标准的敏感性值为0%至16%，特异性值为95%至100%。组内合并心电图标准并未显著提高敏感性，且常使特异性降至不可接受的低水平。心电图在检测病态肥胖患者心室肥厚和腔室扩大方面的能力非常有限。
