Candidate at Faculty of Medicine, University of Toronto, Toronto, Canada.
Department of Pediatric Cardiology, University of Alberta, Edmonton, Canada.
Sci Rep. 2020 Jun 22;10(1):10027. doi: 10.1038/s41598-020-66987-7.
Left atrial enlargement (LAE) is a marker for diastolic cardiac dysfunction. Echocardiograms are considered the gold-standard for diagnosis, but given their wider access and lower economic cost, electrocardiograms (ECGs) may be useful in identifying patients who would benefit from further investigation. This study investigates the utility of ECG criteria to diagnose LAE in pediatric patients. A retrospective chart review (n = 492) was conducted in patients whose echocardiograms demonstrated LAE by left atrial indexed diameter z-score ≥2.0 and/or increased left atrial to aortic root ratio at various cutoffs (≥1.4, ≥1.6, ≥1.8). ECG criteria studied included: (1) P wave ≥110 msec, (2) P mitrale ≥40 msec, in LII (3) terminal negative P wave deflection in lead V1 > 40 msec, and (4) P/PR segment >1.6 in lead II. Sensitivity, specificity, Cohen's Kappa coefficient (κ), and ROC curves were calculated. A combination of P mitrale ≥40 msec and terminal negative P wave deflection in lead V1 > 40 msec yielded the greatest agreement (κ = 0.221, 95%CI 0.060-0.382), but all ECG criteria used to diagnose LAE had poor diagnostic value (AUC < 0.60). The present ECG criteria should not be used to diagnose LAE in the absence of an echocardiogram and findings should be considered in the context of clinical symptoms.
左心房扩大（LAE）是舒张性心脏功能障碍的标志物。超声心动图被认为是诊断的金标准，但鉴于心电图（ECG）的广泛应用和较低的经济成本，它可能有助于识别出需要进一步检查的患者。本研究旨在探讨心电图标准在儿科患者 LAE 诊断中的应用。对超声心动图显示左心房指数直径 z 评分≥2.0 和/或左心房与主动脉根部比值增加（≥1.4、≥1.6、≥1.8）的患者进行了回顾性图表审查（n=492）。研究的心电图标准包括：（1）P 波≥110 msec，（2）LII 导联 P 波终末负向偏转≥40 msec，（3）P 波时限≥40 msec，（4）Ⅱ导联 P/PR 段>1.6。计算了敏感性、特异性、Cohen's Kappa 系数（κ）和 ROC 曲线。P 波时限≥40 msec 和 V1 导联终末负向 P 波偏转>40 msec 的组合具有最大的一致性（κ=0.221，95%CI 0.060-0.382），但所有用于诊断 LAE 的心电图标准的诊断价值均较差（AUC<0.60）。在没有超声心动图的情况下，不应使用目前的心电图标准来诊断 LAE，并且应结合临床症状来考虑这些发现。
