Siegel R J, Roberts W C
Am Heart J. 1982 Feb;103(2):210-21. doi: 10.1016/0002-8703(82)90494-x.
Most ECG studies in patients with aortic valve stenosis (AS) have involved living patients in whom the status of the left ventricular (LV) myocardium, epicardial coronary arteries, and mitral valve was not precisely known. We examined the 12-lead ECG recorded within 2 months of death in 50 patients aged 16 to 65 years (mean 48) with peak systolic pressure gradients (PSPG) across the aortic valve ranging from 52 to 180 mm Hg (mean 98) and anatomically normal mitral valves. Excluding four patients with complete left bundle branch block (LBBB), 44 (96%) of the other 46 patients had the usual voltage criteria for LV hypertrophy (LVH). Measurement of the total 12-lead QRS amplitude, which ranged from 144 to 417 mm (10 mm = 1 mV), (mean 257) proved useful for it correlated directly with PSPG across the aortic valve and, when the four LBBB patients were excluded, with the peak LV systolic pressure. The total 12-lead QRS amplitude (mm) was similar in most patients to the LV systolic pressure (mm Hg). Thus, subtraction of the indirect systemic arterial systolic pressure (mm Hg) from the total 12-lead QRS amplitude (mm) provides a reasonable noninvasive prediction of the PSPG across the aortic valve in patients with moderate to severe AS. Additionally, the mean of the total 12-lead QRS amplitude was significantly (p less than 0.05) greater in the 11 younger (less than or equal to 40 years) than in the 39 older patients (278 mm vs 257 mm), in the 14 women than in the 36 men (277 mm vs 240 mm), in the 22 patients with heavier (greater than 600 gm) hearts (274 mm vs 244 mm), in the 34 patients without compared to the 16 with significant coronary arterial narrowing (270 mm vs 238 mm), and in the 22 patients without compared to the 24 with ECG myocardial damage patterns (269 mm vs 236 mm).
大多数针对主动脉瓣狭窄（AS）患者的心电图研究都涉及在世患者，而这些患者左心室（LV）心肌、心外膜冠状动脉和二尖瓣的状况并不确切知晓。我们检查了50例年龄在16至65岁（平均48岁）的患者在死亡前2个月内记录的12导联心电图，这些患者的主动脉瓣跨瓣收缩压峰值梯度（PSPG）在52至180 mmHg（平均98 mmHg）之间，且二尖瓣解剖结构正常。排除4例完全性左束支传导阻滞（LBBB）患者后，其余46例患者中有44例（96%）符合左心室肥厚（LVH）的常用电压标准。测量12导联QRS波总振幅，范围为144至417 mm（10 mm = 1 mV）（平均257），结果证明其有用，因为它与主动脉瓣跨瓣PSPG直接相关，并且在排除4例LBBB患者后，与左心室收缩压峰值相关。大多数患者12导联QRS波总振幅（mm）与左心室收缩压（mmHg）相似。因此，用12导联QRS波总振幅（mm）减去间接的体循环动脉收缩压（mmHg），可为中重度AS患者的主动脉瓣跨瓣PSPG提供合理的无创预测。此外，11例较年轻（小于或等于40岁）患者的12导联QRS波总振幅平均值显著（p小于0.05）高于39例老年患者（278 mm对257 mm），14例女性患者高于36例男性患者（277 mm对240 mm），22例心脏较重（大于600 g）的患者高于28例心脏较轻的患者（274 mm对244 mm），34例无明显冠状动脉狭窄的患者高于16例有明显冠状动脉狭窄的患者（270 mm对238 mm），22例无心电图心肌损伤模式的患者高于24例有心电图心肌损伤模式的患者（269 mm对236 mm）。
