Li Gui, Jin Lingdan, Weng Zhiyuan, Jin Xueqing, Lin Xiaoyan, Chen Shuling
Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
Department of Ultrasound, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
Front Cardiovasc Med. 2024 Sep 19;11:1354364. doi: 10.3389/fcvm.2024.1354364. eCollection 2024.
While electrocardiographic parameters of hypertensive left ventricular hypertrophy (H-LVH) are well known, limited data are available regarding hypertrophic cardiomyopathy (HCM). This study was to assess the diagnostic value of electrocardiographic voltage parameters in HCM.
Included patients with HCM treated between March 2015 and May 2023. Voltage parameters (S-L, Cornell, Cornell product, Lewis, Peguero, and modified Cornell voltages) and echocardiography were evaluated. Receiver operating characteristic (ROC) curves were used to assess the diagnostic value of electrocardiogram in HCM. The multiple linear regression was conducted to analyze the correlation between electrocardiogram indicators and cardiac diastolic function.
The highest sensitivity for HCM was Peguero voltage (70.4%; 88.6% specificity). The Peguero voltage had high sensitivity in male (63.8%) and female patients (84.9%), those aged <65 years (71.6%) and ≥65 years (68.3%), with non-apical HCM (AHCM) (76.7%), obstructive HCM (82.1%), and non-obstructive HCM (66.9%). The sensitivity of the S-L voltage was high in AHCM (72.2%). The sensitivity for HCM reached 88.7% when the S-L and Peguero voltages were combined. The modified Cornell index had the highest area under the curve (0.88, 95% CI: 0.84-0.91), and its optimal cutoff value was 2.05 mV in males (77.6% sensitivity and 74% specificity) and 1.935 mV in females (90.6% sensitivity and 91.4% specificity). Peguero voltage (beta = 0.154, = 0.034) and S (beta = 0.223 = 0.004) were independently correlated with E/e', an index of left ventricular diastolic function.
The Peguero voltage had high sensitivity and specificity for detecting the presence of HCM. It was positively correlated with E/e' in patients with HCM. For AHCM, the S-L voltage was more advantageous. Combining the S-L voltage with the Peguero voltage further improves the sensitivity for HCM and thus could be used to improve the screening of HCM in clinical practice. The S and modified Cornell voltage also had good diagnostic performance, especially in females.
虽然高血压左心室肥厚（H-LVH）的心电图参数广为人知，但关于肥厚型心肌病（HCM）的数据有限。本研究旨在评估心电图电压参数在HCM中的诊断价值。
纳入2015年3月至2023年5月期间接受治疗的HCM患者。评估电压参数（S-L、康奈尔、康奈尔乘积、刘易斯、佩格罗和改良康奈尔电压）和超声心动图。采用受试者工作特征（ROC）曲线评估心电图在HCM中的诊断价值。进行多元线性回归分析心电图指标与心脏舒张功能之间的相关性。
对HCM敏感性最高的是佩格罗电压（70.4%；特异性88.6%）。佩格罗电压在男性（63.8%）和女性患者（84.9%）、年龄<65岁（71.6%）和≥65岁（68.3%）、非心尖部HCM（AHCM）（76.7%）、梗阻性HCM（82.1%）和非梗阻性HCM（66.9%）中具有较高敏感性。S-L电压在AHCM中敏感性较高（72.2%）。当S-L电压和佩格罗电压联合使用时，对HCM的敏感性达到88.7%。改良康奈尔指数的曲线下面积最大（0.88，95%CI：0.84-0.91），其最佳截断值在男性中为2.05mV（敏感性77.6%，特异性74%），在女性中为1.935mV（敏感性90.6%，特异性91.4%）。佩格罗电压（β = 0.154，P = 0.034）和S波（β = 0.223，P = 0.004）与左心室舒张功能指标E/e'独立相关。
佩格罗电压对检测HCM的存在具有较高的敏感性和特异性。它与HCM患者的E/e'呈正相关。对于AHCM，S-L电压更具优势。将S-L电压与佩格罗电压联合使用可进一步提高对HCM检测的敏感性，因此可用于改善临床实践中HCM的筛查。S波和改良康奈尔电压也具有良好的诊断性能，尤其是在女性中。
