心脏计算机断层扫描和心电图在高血压个体中识别左心室肥厚：一项基于人群的研究。

Left ventricular hypertrophy identified by cardiac computed tomography and ECG in hypertensive individuals: a population-based study.

机构信息

Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark.

Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.

出版信息

J Hypertens. 2019 Apr;37(4):739-746. doi: 10.1097/HJH.0000000000001962.

DOI:10.1097/HJH.0000000000001962

PMID:30817455

Abstract

OBJECTIVES

Screening of left ventricular hypertrophy (LVH) is a biomarker of organ damage in hypertensive individuals and associated with increased mortality. Cardiac computed tomography (CT) is widely expanding worldwide; however, the value of CT assessment of LVH is unknown. We aimed to identify individuals with LVH using both cardiac CT and electrocardiograms (ECG) and to explore potential differences between these phenotypical distinct diagnostic modalities.

METHODS

Participants in the Copenhagen General Population Study underwent 12-lead ECG and cardiac CT and were evaluated for the presence of LVH. Multiple ECG signs of LVH were compared with LVH by CT.

RESULTS

Out of 4942 participants, 1347 had untreated hypertension and in this group, 13% presented with anatomical LVH by CT and 10% by ECG with an overlap of 4%. ECG signs of LVH had negative predictive values between 87 and 89% compared with CT. Using a combination of the Sokolow-Lyon index, the Cornell voltage duration product and/or a Romhilt-Estes score at least 4, lead to an increased C-statistics (P < 0.001) compared with the use of any single ECG sign of LVH. Individuals with solely CT but not ECG signs of LVH had higher SBPs (152 vs. 144 mmHg, P < 0.001) and larger left atria (49 vs. 45 ml/m, P < 0.001) compared with individuals with solely ECG LVH.

CONCLUSION

CT and ECG identifies LVH in 19% of hypertensive individuals with only a small diagnostic overlap. Commonly used ECG criteria for LVH cannot safely rule out the presence of anatomical LV organ damage.

摘要

目的

左心室肥厚（LVH）的筛查是高血压个体器官损伤的生物标志物，与死亡率增加相关。心脏计算机断层扫描（CT）在全球范围内广泛应用；然而，CT 评估 LVH 的价值尚不清楚。我们旨在使用心脏 CT 和心电图（ECG）来识别 LVH 患者，并探索这些表型不同的诊断方式之间的潜在差异。

方法

哥本哈根普通人群研究的参与者接受了 12 导联心电图和心脏 CT，并评估了 LVH 的存在。比较了多种心电图 LVH 征象与 CT 所示 LVH。

结果

在 4942 名参与者中，有 1347 名未经治疗的高血压患者，在这一组中，有 13%的患者通过 CT 显示有解剖学 LVH，有 10%的患者通过 ECG 显示有 LVH，两者存在 4%的重叠。心电图 LVH 征象的阴性预测值在 87%至 89%之间，而 CT 的阴性预测值则为 87%至 89%。与使用任何单一心电图 LVH 征象相比，使用 Sokolow-Lyon 指数、Cornell 电压持续时间乘积和/或 Romhilt-Estes 评分至少 4 分的组合，可以提高 C 统计量（P<0.001）。仅 CT 而非 ECG 有 LVH 征象的个体的 SBP（152 比 144mmHg，P<0.001）和左心房容积（49 比 45ml/m，P<0.001）均高于仅 ECG 有 LVH 征象的个体。