Xia Yu, Li Xiaofeng, Zhang Hao, Liu Li, Fu Lijuan, Yan Wei, Li Qingxia, Zhang Yukun, Yu Miao, Liu Jun, Fang Pihua
State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, Qitaihe City People's Hospital, Heilongjiang, China.
Cardiology. 2020;145(5):294-302. doi: 10.1159/000505421. Epub 2020 Apr 14.
Based on a small sample of patients with hypertension, a few studies have reported that the newly proposed SD + SV4 criterion for left ventricular hypertrophy (LVH) is better than traditional criteria. This study aimed to verify the diagnostic capability of the SD + SV4 criterion in a Chinese population with or without hypertension and to analyze the factors affecting the diagnostic accuracy of LVH.
A total of 248 patients with LVH or paroxysmal supraventricular tachycardia (PSVT) discharged from Fuwai Hospital from January 2010 to July 2018 were enrolled. Patients with LVH were diagnosed according to the left ventricular mass index calculated by the echocardiogram parameter as the gold standard in this study. The receiver operating curve (ROC) curve was performed to assess the diagnostic capability and cut-off values of the SD + SV4, RavL + SV3, and SV1 + RV5/RV6 criteria for LVH. Then, multivariate logistic regression analyses were performed to in-vestigate the factors affecting the accuracy of the SD + SV4 criterion.
There were 170 (68.5%) patients with hypertension and 110 (44.4%) with PSVT. According to echocardiography, 107 (43.1%) patients were diagnosed with LVH. The area under the curve (AUC) of the SD + SV4 criterion was the largest compared with that of the RavL + SV3 and SV1 + RV5/RV6 criteria (AUC 0.765 vs. 0.718 vs. 0.713, respectively). The sex-specific SD + SV4 criterion had the highest consistency with the gold standard (r = 0.532 ± 0.054, p < 0.01), accompanied by the highest sensitivity (70.1%) and specificity (85.8%). The cut-off values of the sex-specific SD + SV4 criterion for LVH were ≥2.65 mV (male)/2.15 mV (female). The left ventricular ejection fraction (LVEF; OR 0.920, 95% CI 0.882-0.959, p < 0.001) was significantly different between the SD + SV4 criterion and the gold standard for LVH after adjusting for hypertension, PSVT history, body surface area, interventricular septum thickness, posterior wall thickness, and left ventricular internal diameter.
The newly proposed SD + SV4 criterion provides improved sensitivity and accuracy for the diagnosis of LVH in the Chinese population. A decrease in LVEF is an independent factor affecting the diagnostic accuracy of LVH.
基于一小部分高血压患者样本，一些研究报告称，新提出的用于诊断左心室肥厚（LVH）的SD + SV4标准优于传统标准。本研究旨在验证SD + SV4标准在中国高血压患者和非高血压患者中的诊断能力，并分析影响LVH诊断准确性的因素。
纳入2010年1月至2018年7月从阜外医院出院的248例LVH或阵发性室上性心动过速（PSVT）患者。在本研究中，以超声心动图参数计算的左心室质量指数作为金标准来诊断LVH患者。绘制受试者工作特征曲线（ROC）以评估SD + SV4、RavL + SV3和SV1 + RV5/RV6标准对LVH的诊断能力和临界值。然后，进行多因素逻辑回归分析以研究影响SD + SV4标准准确性的因素。
有170例（68.5%）高血压患者和110例（44.4%）PSVT患者。根据超声心动图，107例（43.1%）患者被诊断为LVH。与RavL + SV3和SV1 + RV5/RV6标准相比，SD + SV4标准的曲线下面积（AUC）最大（AUC分别为0.765、0.718和0.713）。性别特异性SD + SV4标准与金标准的一致性最高（r = 0.532±0.054，p < 0.01），同时具有最高的敏感性（70.1%）和特异性（85.8%）。LVH的性别特异性SD + SV4标准的临界值为男性≥2.65 mV/女性≥2.15 mV。在校正高血压、PSVT病史、体表面积、室间隔厚度、后壁厚度和左心室内径后，SD + SV4标准与LVH金标准之间的左心室射血分数（LVEF；OR 0.920，95%CI 0.882 - 0.959，p < 0.001）存在显著差异。
新提出的SD + SV4标准为中国人群LVH的诊断提供了更高的敏感性和准确性。LVEF降低是影响LVH诊断准确性的独立因素。
