Department of Cardiology, Rigshospitalet, DK-2100, Copenhagen, Denmark.
Department of Health Science and Technology, Aalborg University, DK-9220, Aalborg, Denmark.
Hypertens Res. 2022 Aug;45(8):1382-1391. doi: 10.1038/s41440-022-00918-z. Epub 2022 Apr 28.
Left atrial enlargement (LAE) is associated with hypertension and an increased risk of cardiovascular morbidity and mortality. Guidelines for hypertension recommend LAE evaluation. We aimed to estimate the agreement of LAE as assessed by 12-lead electrocardiogram (ECG) and cardiac computed tomography (CT) in both the general population and hypertensive individuals. Cardiac CT and ECG were used to evaluate the presence of LAE in participants in the Copenhagen General Population Study. LAE, is defined as an LA volume above the 97.5% upper confidence limit by cardiac CT, as compared with multiple ECG criteria for LAE. A total of 3507 participants (47% males, age: 60 ± 10 years) were included. The prevalence of CT-defined LAE was 5.9% in the total population and 8.7% in participants with hypertension. In hypertensive individuals, LAE was identified by CT or by ECG in 31% with only a 4% overlap. ECG signs for anatomical LAE by CT had high negative predictive values between 93 and 96% but low sensitivity and positive predictive values. Specificity ranged from 27 to 93%. P-wave duration >120 ms was the best performing criterion, with a sensitivity of 48%, a specificity of 78%, and the highest area under the curve (0.66). We found a discrepancy in LAE prevalence when participants were assessed by CT and ECG, indicating that the two diagnostic modalities reflect different phenotypes of left atrial alterations. The diagnostic performance of ECG criteria for identifying anatomical LAE was poor.
左心房扩大（LAE）与高血压以及心血管发病率和死亡率增加有关。高血压指南建议评估 LAE。我们旨在评估 12 导联心电图（ECG）和心脏计算机断层扫描（CT）在一般人群和高血压个体中评估 LAE 的一致性。心脏 CT 和 ECG 用于评估哥本哈根普通人群研究中参与者的 LAE 存在情况。LAE 定义为心脏 CT 上 LA 体积超过 97.5%的置信上限，与 LAE 的多个 ECG 标准相比。共有 3507 名参与者（47%为男性，年龄：60±10 岁）被纳入。总人群中 CT 定义的 LAE 患病率为 5.9%，高血压患者中为 8.7%。在高血压患者中，LAE 通过 CT 或 ECG 确定，只有 31%重叠，重叠率为 4%。LAE 的 CT 解剖学标志的 ECG 征象具有 93%至 96%的高阴性预测值，但敏感性和阳性预测值较低。特异性范围从 27%到 93%。P 波持续时间>120ms 是表现最佳的标准，敏感性为 48%，特异性为 78%，曲线下面积（AUC）最高为 0.66。我们发现参与者通过 CT 和 ECG 评估时 LAE 患病率存在差异，表明这两种诊断方法反映了左心房改变的不同表型。ECG 标准识别解剖学 LAE 的诊断性能较差。
