Braunstein Eric D, Croft Lori B, Halperin Jonathan L, Liao Steve L
Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, NY 10467, United States.
Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, NY 10029, United States.
World J Cardiol. 2019 Mar 26;11(3):94-102. doi: 10.4330/wjc.v11.i3.94.
Left ventricular hypertrophy (LVH) is a common manifestation of cardiovascular disease and a risk factor for cardiovascular morbidity and mortality, but available methods for its electrocardiographic (ECG) diagnosis have limited accuracy.
To investigate findings associated with LVH on ECG and developed an improved system for the diagnosis of LVH.
A cohort study comparing ECG data acquired within 30 days of transthoracic echocardiography (TTE) was performed. Multivariate regression analysis identified ECG findings associated with increased LV mass and mass index. A scoring system was derived and performance compared to established criteria for LVH.
Data from 5486 outpatients with TTEs and corresponding ECGs were included in the derivation cohort, 333 (6.1%) of whom had LVH by TTE. In the primary regression analysis, findings associated with LVH were amplitudes of Q in V3, R in V6, S in V3, T in V6, P' in V1, P in V6, as well as R and T-axis discordance, R peak time in V6, QRS duration, weight, height, sex, and age. From this we derived a score consisting of 5 criteria, and validated it in an independent cohort of 910 patients. With a threshold of 1.5 points, sensitivity and specificity were 67.9% and 81.4%, and 62.5% and 83.2% in the derivation and validation cohorts, respectively. With a threshold of 2 points, sensitivity and specificity were 42.3% and 93.0%, and 37.5% and 93.4% in these cohorts.
This score had superior sensitivity for detection of LVH by ECG while making a modest sacrifice in specificity compared to conventional criteria.
左心室肥厚（LVH）是心血管疾病的常见表现，也是心血管发病和死亡的危险因素，但现有的心电图（ECG）诊断方法准确性有限。
研究ECG上与LVH相关的表现，并开发一种改进的LVH诊断系统。
进行一项队列研究，比较经胸超声心动图（TTE）30天内获取的ECG数据。多变量回归分析确定与左心室质量和质量指数增加相关的ECG表现。得出一个评分系统，并将其性能与既定的LVH标准进行比较。
推导队列纳入了5486例有TTE检查及相应ECG的门诊患者数据，其中333例（6.1%）经TTE诊断为LVH。在初步回归分析中，与LVH相关的表现包括V3导联Q波振幅、V6导联R波振幅、V3导联S波振幅、V6导联T波振幅、V1导联P'波、V6导联P波，以及R波和T波轴不一致、V6导联R波峰时间、QRS波时限、体重、身高、性别和年龄。由此得出一个由5项标准组成的评分，并在一个910例患者的独立队列中进行验证。阈值为1.5分时，推导队列和验证队列的敏感性和特异性分别为67.9%和81.4%，以及62.5%和83.2%。阈值为2分时，这些队列中的敏感性和特异性分别为42.3%和93.0%，以及37.5%和93.4%。
与传统标准相比，该评分在ECG检测LVH方面具有更高的敏感性，只是在特异性方面有一定牺牲。
