Hedman Kristofer, Patti Alessandro, Moneghetti Kegan J, Hsu David, Christle Jeffrey W, Ashley Euan, Hadley David, Haddad Francois, Froelicher Victor
Department of Medicine, Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA.
Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköpings universitet, Linköping, Sweden.
BMJ Open Sport Exerc Med. 2020 Mar 8;6(1):e000696. doi: 10.1136/bmjsem-2019-000696. eCollection 2020.
Available ECG criteria for detection of left ventricular (LV) hypertrophy have been reported to have limited diagnostic capability. Our goal was to describe how the distance between the chest wall and the left ventricle determined by echocardiography affected the relationship between ECG voltage and LV mass (LVM) in athletes.
We retrospectively evaluated digitised ECG data from college athletes undergoing routine echocardiography as part of their preparticipation evaluation. Along with LV mass and volume, we determined the chest wall-LV distance in the parasternal short-axis and long-axis views from two-dimensional transthoracic echocardiographic images and explored the relation with ECG QRS voltages in all leads, as well as summed voltages as included in six major ECG-LVH criteria.
239 athletes (43 women) were included (age 19±1 years). In men, greater LV-chest wall distance was associated with higher R-wave amplitudes in leads aVL and I (R=0.20 and R=0.25, both p<0.01), while in women greater distance was associated with higher R-amplitudes in V5 and V6 (R=0.42 and R=0.34, both p<0.01). In women, the chest wall-LV distance was the only variable independently (and positively) associated with R V5 voltage, while LVM, height and weight contributed to the relationship in men.
The chest wall-LV distance was weakly associated with ECG voltage in athletes. Inconsistent associations in men and women imply different intrathoracic factors affecting impedance and conductance between sexes. This may help explain the poor relationship between QRS voltage and LVM in athletes.
据报道，现有的用于检测左心室（LV）肥厚的心电图标准诊断能力有限。我们的目标是描述经超声心动图测定的胸壁与左心室之间的距离如何影响运动员心电图电压与左心室质量（LVM）之间的关系。
我们回顾性评估了大学运动员的数字化心电图数据，这些运动员作为参与赛前评估的一部分接受了常规超声心动图检查。除了左心室质量和容积外，我们还从二维经胸超声心动图图像的胸骨旁短轴和长轴视图中确定了胸壁 - 左心室距离，并探讨了其与所有导联心电图QRS电压以及六个主要心电图左心室肥厚标准中包含的总和电压之间的关系。
纳入239名运动员（43名女性）（年龄19±1岁）。在男性中，更大的左心室 - 胸壁距离与aVL和I导联中更高的R波振幅相关（R = 0.20和R = 0.25，均p<0.01），而在女性中，更大的距离与V5和V6导联中更高的R波振幅相关（R = 0.42和R = 0.34，均p<0.01）。在女性中，胸壁 - 左心室距离是唯一与R V5电压独立（且呈正相关）相关的变量，而在男性中，左心室质量、身高和体重对这种关系有影响。
胸壁 - 左心室距离与运动员的心电图电压弱相关。男性和女性中不一致的关联意味着不同的胸腔内因素影响两性之间的阻抗和传导。这可能有助于解释运动员中QRS电压与左心室质量之间的不良关系。
