Tereshchenko Larisa G
Oregon Health & Science University, Portland, Oregon, USA.
Comput Cardiol (2010). 2018 Sep;45. doi: 10.22489/cinc.2018.165. Epub 2019 Jun 24.
This review summarizes recent findings and discusses a clinical significance of a vectorcardiographic (VCG) Global electrical heterogeneity (GEH). GEH concept is based on the concept of the spatial ventricular gradient (SVG), which is a global measure of the dispersion of total recovery time. We quantify GEH by measuring five features of the SVG vector (SVG magnitude, direction (azimuth and elevation), a scalar value, and spatial QRS-T angle) on orthogonal XYZ ECG. In analysis of more than 20,000 adults we showed that GEH is independently associated with sudden cardiac death (SCD) after adjustment for demographics, cardiovascular disease (time-updated incident non-fatal cardiovascular events [coronary heart disease, heart failure, stroke, atrial fibrillation, use of beta-blockers], and known risk factors [cholesterol, triglycerides, physical activity index, smoking, diabetes, obesity, hypertension, anti-hypertensive medications, creatinine, alcohol intake, left ventricular ejection fraction, and time-updated ECG metrics (heart rate, QTc, QRS duration, ECG-left ventricular hypertrophy, bundle branch block or interventricular conduction delay)]. This finding suggests that GEH represents an independent electrophysiological substrate of SCD.
本综述总结了近期的研究结果，并讨论了向量心电图（VCG）整体电不均一性（GEH）的临床意义。GEH概念基于空间心室梯度（SVG）的概念，SVG是总恢复时间离散度的一种整体测量方法。我们通过在正交XYZ心电图上测量SVG向量的五个特征（SVG大小、方向（方位角和仰角）、一个标量值以及空间QRS-T角）来量化GEH。在对2万多名成年人的分析中，我们发现，在对人口统计学因素、心血管疾病（最新发生的非致命性心血管事件[冠心病、心力衰竭、中风、心房颤动、使用β受体阻滞剂]）以及已知危险因素[胆固醇、甘油三酯、体力活动指数、吸烟、糖尿病、肥胖、高血压、抗高血压药物、肌酐、酒精摄入量、左心室射血分数以及最新心电图指标（心率、QTc、QRS时限、心电图左心室肥厚、束支传导阻滞或室内传导延迟）]进行校正后，GEH与心源性猝死（SCD）独立相关。这一发现表明，GEH代表了SCD的一种独立电生理基础。
