Recke S H, Marienhagen J, Feistel H, Platsch G, Bock E, von der Emde J
University Heart Centre, University of Erlangen, Nuremberg, Germany.
Int J Cardiol. 1993 Dec 15;42(2):129-38. doi: 10.1016/0167-5273(93)90082-r.
In order to define which of selected ECG variables could indicate irreversibly impaired myocardial function in chronic aortic regurgitation 54 patients were stratified according to normal (> or = 50%; Group A, n = 41) or subnormal radionuclide left ventricular ejection fraction (LVEF < 50%; Group B, n = 13) late after aortic valve replacement. Preoperatively, Group B patients had a significantly greater QRS duration, greater R-peak time (RPT) prolongation in I, V5 or V6, greater RPT relative to the S-peak time of the maximum S in V1, V2 or V3 (R-peak delay) and a greater negative T-wave in I or V6, as compared with Group A. These ECG variables together with preoperative angiocardiographic LVEF and end-systolic volume index were subjected to stepwise linear discriminant analysis. The maximum RPT, angio-LVEF and the maximum RPT relative to the S-peak time of the maximum S in V1, V2 or V3 emerged as the most promising variables. Of of Group A patients 82.9% and 84.6% of Group B patients were correctly classified by the three variables. If applied separately, APT prolongation or the presence of the R-peak delay in the left-sided leads, although less sensitive, have reasonably high specificity as risk indicators of irreversibly impaired chamber function, their positive predictive value being 60 and 62.5%, respectively. In conjunction with preoperative LVEF the diagnostic contribution of the two ECG variables amounts to the greatest overall separation of postoperatively preserved from irreversibly impaired systolic function.
为了确定在慢性主动脉瓣反流中，哪些选定的心电图变量可提示心肌功能出现不可逆损害，我们根据主动脉瓣置换术后较晚时间点的放射性核素左心室射血分数（LVEF）正常（≥50%；A组，n = 41）或低于正常水平（LVEF < 50%；B组，n = 13），将54例患者进行了分层。术前，与A组相比，B组患者的QRS时限明显更长，I、V5或V6导联的R波峰时间（RPT）延长更明显，相对于V1、V2或V3导联中最大S波的S波峰时间，RPT更长（R波峰延迟），且I或V6导联的T波负向更大。将这些心电图变量与术前血管造影LVEF和收缩末期容积指数进行逐步线性判别分析。最大RPT、血管造影LVEF以及相对于V1、V2或V3导联中最大S波的S波峰时间的最大RPT成为最有前景的变量。根据这三个变量，A组患者中有82.9%、B组患者中有84.6%被正确分类。如果单独应用，左侧导联的RPT延长或R波峰延迟的存在，虽然敏感性较低，但作为心室功能不可逆损害的风险指标具有相当高的特异性，其阳性预测值分别为60%和62.5%。与术前LVEF相结合，这两个心电图变量的诊断作用在最大程度上实现了术后保留的收缩功能与不可逆损害的收缩功能之间的区分。
