右心室肥厚的心电图表现可能有助于识别扩张型心肌病患者的肺动脉高压。
Electrocardiogram signs of right ventricular hypertrophy may help identify pulmonary hypertension in patients with dilated cardiomyopathy.
作者信息
Chen Chengzhi, Liu Jingyan, Liu Zhiyong, He Xin, Yuan Xuming, Ouyang Xiufen, Wang Lei, Li Xiaoping
机构信息
Department of Cardiology, Liuyang People Hospital, Liuyang 410300, China.
Department of Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, China.
出版信息
Int J Cardiol Heart Vasc. 2018 Dec 27;22:61-66. doi: 10.1016/j.ijcha.2018.12.006. eCollection 2019 Mar.
OBJECTIVE
To the authors' knowledge, limited data are available regarding the association between Electrocardiogram (ECG) signs of right ventricular hypertrophy (RVH) and pulmonary hypertension (PH) in patients with dilated cardiomyopathy (DCM). We aimed to assess the accuracy of the recommended ECG criteria of RVH for predicting PH in patients with DCM.
METHODS
According to the definition of PH (mPAP ≥ 25 mm Hg), 35 patients with DCM were divided into 2 groups: DCM with PH (n = 22) and DCM without PH (n = 13). Right heart catheterization was performed in all patients. Seventeen parameters of RVH recommended by the AHA/ACCF/HRS for diagnosis of RVH on ECG were determinded.
RESULTS
The following parameters were correlated with mPAP: R > 6 mm, S > 10 mm, R:S < 0.4, R + S > 10.5 mm and P amplitude. The following parameters were significantly different between DCM patients with and without PH: S in V (S) > 10 mm, S in V (S) > 3 mm, R:S ratio in V (R:S) < 0.75, R + S > 10.5 mm, S > R inI, S > R inII and R:S > R:S , although results were no longer significant after correcting for multiple comparisons. High specificity (92.3-100%), lowsensitivity (31.8-50%), high positive predictive value, and low negative predictive value of established parameters of RVH were noted for predicting PH in patients with DCM.
CONCLUSION
Several ECG signs of RVH may be useful for in the diagnosis PH in patients with DCM.
目的
据作者所知，关于扩张型心肌病（DCM）患者右心室肥厚（RVH）的心电图（ECG）征象与肺动脉高压（PH）之间的关联，现有数据有限。我们旨在评估推荐的RVH心电图标准对预测DCM患者PH的准确性。
方法
根据PH的定义（平均肺动脉压[mPAP]≥25 mmHg），将35例DCM患者分为两组：合并PH的DCM（n = 22）和不合并PH的DCM（n = 13）。所有患者均进行了右心导管检查。测定了美国心脏协会（AHA）/美国心脏病学会基金会（ACCF）/心律学会（HRS）推荐的用于心电图诊断RVH的17项参数。
结果
以下参数与mPAP相关：R＞6 mm、S＞10 mm、R∶S＜0.4、R＋S＞10.5 mm以及P波振幅。合并和不合并PH的DCM患者之间，以下参数存在显著差异：V导联的S波（SV）＞10 mm、V导联的S波（SV）＞3 mm、V导联的R∶S比值（R∶S）＜0.75、R＋S＞10.5 mm、I导联中S＞R、II导联中S＞R以及R∶S＞R∶S ，不过在进行多重比较校正后，结果不再具有显著性。RVH既定参数在预测DCM患者PH方面具有高特异性（92.3% - 100%）、低敏感性（31.8% - 50%）、高阳性预测值和低阴性预测值。
结论
RVH的几种心电图征象可能有助于诊断DCM患者的PH。
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