Okin P M, Roman M J, Devereux R B, Kligfield P
Department of Medicine, New York Hospital-Cornell Medical Center, New York 10021.
J Am Coll Cardiol. 1995 Feb;25(2):417-23. doi: 10.1016/0735-1097(94)00371-v.
This study was conducted to validate the hypothesis that the product of QRS voltage and duration, as an approximation of the time-voltage area of the QRS complex, can improve the electrocardiographic (ECG) detection of echocardiographically determined left ventricular hypertrophy and to further assess the relative contribution of QRS duration to the ECG detection of hypertrophy.
The ECG identification of left ventricular hypertrophy has been limited by the poor sensitivity of standard voltage criteria alone. However, increases in left ventricular mass can be more accurately related to increases in the time-voltage area of the QRS complex than to changes in QRS voltage or duration alone.
Standard 12-lead ECGs and echocardiograms were obtained for 389 patients, including 116 patients with left ventricular hypertrophy. Simple voltage-duration products were calculated by multiplying Cornell voltage by QRS duration (Cornell product) and the 12-lead sum of voltage by QRS duration (12-lead product).
In a stepwise logistic regression model that also included Cornell voltage, Sokolow-Lyon voltage, age and gender, QRS duration remained a highly significant predictor of the presence of left ventricular hypertrophy (chi-square 26.9, p < 0.0001). At a matched specificity of 96%, each voltage-duration product significantly improved sensitivity for the detection of left ventricular hypertrophy compared with simple voltage criteria alone (Cornell product 37% vs. Cornell voltage 28%, p < 0.02, and 12-lead product 50% vs. 12-lead voltage 43%, p < 0.005). Sensitivities of both the Cornell product and the 12-lead product were significantly greater than the 27% sensitivity of QRS duration alone (p < 0.01 vs. p < 0.001), the 20% sensitivity of a Romhilt-Estes point score > 4 (p < 0.001) and the 33% sensitivity of the best-fit logistic regression model in this cohort (p < 0.05 vs. p < 0.001).
QRS duration is an independent ECG predictor of the presence of left ventricular hypertrophy, and the simple product of either Cornell voltage or 12-lead voltage and QRS duration significantly improves identification of left ventricular hypertrophy relative to other ECG criteria that use QRS duration and voltages in linear combinations.
本研究旨在验证以下假设，即QRS波电压与时限的乘积作为QRS波群时间-电压面积的近似值，可改善心电图（ECG）对超声心动图测定的左心室肥厚的检测，并进一步评估QRS时限对ECG检测肥厚的相对贡献。
仅靠标准电压标准对左心室肥厚进行心电图识别，其敏感性较差。然而，左心室质量的增加与QRS波群时间-电压面积的增加更准确相关，而非单独与QRS波电压或时限的变化相关。
对389例患者进行了标准12导联心电图和超声心动图检查，其中包括116例左心室肥厚患者。通过将康奈尔电压乘以QRS时限（康奈尔乘积）以及将12导联电压总和乘以QRS时限（12导联乘积）来计算简单的电压-时限乘积。
在一个逐步逻辑回归模型中，该模型还纳入了康奈尔电压、索科洛夫-里昂电压、年龄和性别，QRS时限仍然是左心室肥厚存在的高度显著预测因子（卡方值26.9，p < 0.0001）。在匹配的特异性为96%时，与单独的简单电压标准相比，每个电压-时限乘积显著提高了检测左心室肥厚的敏感性（康奈尔乘积为37%，而康奈尔电压为28%，p < 0.02；12导联乘积为50%，而12导联电压为43%，p < 0.005）。康奈尔乘积和12导联乘积的敏感性均显著高于单独QRS时限的27%敏感性（p < 0.01对比p < 0.001）、Romhilt-Estes积分>4时的20%敏感性（p < 0.001）以及该队列中最佳拟合逻辑回归模型的33%敏感性（p < 0.05对比p < 0.001）。
QRS时限是左心室肥厚存在的独立心电图预测因子，相对于其他将QRS时限和电压进行线性组合的心电图标准，康奈尔电压或12导联电压与QRS时限的简单乘积显著改善了左心室肥厚的识别。
