Fragola P V, De Nardo D, Calò L, Cannata D
Department of Internal Medicine, School of Cardiovascular Diseases, University of Rome Tor Vergata, Italy.
Int J Cardiol. 1994 May;44(3):261-70. doi: 10.1016/0167-5273(94)90290-9.
We analysed the diagnostic performance of the signal-averaged QRS duration for the detection of left ventricular hypertrophy in 100 consecutive outpatients (62 men and 38 women; mean age, 49.8 +/- 11.8 years) with essential hypertension and compared the results with some of the currently employed electrocardiographic criteria. Forty-eight healthy subjects (24 men and 24 women; mean age, 46.4 +/- 12.1) with normal physical, electrocardiographic and echocardiographic findings served as a control group to derive normal reference values for signal-averaged QRS duration. Twenty-six (26%) hypertensives (22 men and 4 women) had left ventricular hypertrophy echocardiographically defined as a left ventricular mass > or = 261 g in men and > or = 172 g in women or left ventricular mass index > or = 125 g/m2 in men and > or = 112 g/m2 in women. The signal-averaged QRS duration was different in patients with than in those without left ventricular hypertrophy (102.1 +/- 10.8 vs. 95.8 +/- 8.4 ms; P < 0.01). Also, in the group with left ventricular hypertrophy QRS duration was longer, although not significantly different, in men than in women (103.5 +/- 10.7 vs. 94.2 +/- 8.8 ms; P n.s.). The correlation between the signal-averaged QRS duration and left ventricular mass was weak but statistically significant in men (r = 0.34; P < 0.05) in women (r = 0.30; P < 0.05) and in men and women together (r = 0.42; P < 0.01). Partition values of filtered QRS duration > or = 114 ms in men and > or = 107 ms in women were used to diagnose left ventricular hypertrophy as these values were above the upper limits in our control men and women when 95% confidence intervals were calculated. These criteria were insensitive (12%) but highly specific (99%) for left ventricular hypertrophy. The use of a single threshold value of filtered QRS duration > or = 111 ms in both sexes combined improved sensitivity modestly (15%) while maintaining a good specificity (95%). Also, we tested the following standard electrocardiographic criteria: the Sokolow-Lyon index, the Romhilt-Estes point score > or = 4 points and > or = 5 points, the Cornell voltage criteria, the sum of QRS voltages in all 12 leads > 175 mm, and the QRS duration > 90 ms. Sensitivities ranged from 4% to 58% and specificities from 74% to 99%.(ABSTRACT TRUNCATED AT 400 WORDS)
我们分析了信号平均QRS时限对100例连续性门诊原发性高血压患者（62例男性，38例女性；平均年龄49.8±11.8岁）左心室肥厚的诊断效能，并将结果与一些目前使用的心电图标准进行比较。48例身体、心电图和超声心动图检查结果正常的健康受试者（24例男性，24例女性；平均年龄46.4±12.1岁）作为对照组，以得出信号平均QRS时限的正常参考值。26例（26%）高血压患者（22例男性，4例女性）经超声心动图诊断为左心室肥厚，定义为男性左心室质量≥261 g，女性≥172 g；或男性左心室质量指数≥125 g/m²，女性≥112 g/m²。有左心室肥厚的患者与无左心室肥厚的患者相比，信号平均QRS时限不同（102.1±10.8 vs. 95.8±8.4 ms；P<0.01）。此外，在左心室肥厚组中，男性的QRS时限虽无显著差异，但比女性长（103.5±10.7 vs. 94.2±8.8 ms；P无统计学意义）。信号平均QRS时限与左心室质量之间的相关性较弱，但在男性（r = 0.34；P<0.05）、女性（r = 0.30；P<0.05）以及男女合并组（r = 0.42；P<0.01）中均具有统计学意义。男性滤波后QRS时限≥114 ms、女性≥107 ms的分界值用于诊断左心室肥厚，因为计算95%置信区间时，这些值高于我们对照组男性和女性的上限。这些标准对左心室肥厚不敏感（12%）但特异性高（99%）。男女联合使用滤波后QRS时限≥111 ms的单一阈值可适度提高敏感性（15%），同时保持良好的特异性（95%）。此外，我们还测试了以下标准心电图标准：索科洛夫-里昂指数、Romhilt-Estes积分≥4分和≥5分、康奈尔电压标准、12导联QRS电压总和>175 mm以及QRS时限>90 ms。敏感性范围为4%至58%，特异性范围为74%至99%。（摘要截短至400字）
