Norman J E, Levy D, Campbell G, Bailey J J
National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892.
J Am Coll Cardiol. 1993 Jun;21(7):1680-6. doi: 10.1016/0735-1097(93)90387-g.
The purpose of this study was to use the Framingham data base to devise and test an improvement in an electrocardiographic (ECG) voltage criterion for detecting left ventricular hypertrophy that is gender specific and adjusts for age and obesity.
Electrocardiographic detection of left ventricular hypertrophy has been receiving increasing attention. The "Cornell" ECG voltage, defined as the sum of voltages for the R wave of lead aVL and S wave of lead V3, has been shown to correlate strongly with echocardiographically estimated left ventricular mass. Because the magnitude of this voltage varies with both age and obesity, we have proposed a simple formula for its adjustment for these two variables.
Using linear regression, the adjustment formula was estimated from data on 1,468 men and 1,883 women from the Framingham Heart Study cohort who were free of myocardial infarction and who had both an ECG and an echocardiogram recorded during the same clinic examination. A modified receiver operating characteristic curve method was used to compare sensitivities at the same specificity levels. The adjustment formula was estimated from one randomly chosen half of the study cohort and applied to the other half for evaluation.
Significant improvement in sensitivity for the detection of left ventricular hypertrophy was realized at all levels of specificity. At a specificity level of 98%, the adjustment increased the sensitivity of the Cornell voltage from 10% to 17% in men and from 12% to 22% in women. For severe hypertrophy, defined as a left ventricular mass > 3 SD above the gender-specific mean, the sensitivity increased from 23% to 38% for men and from 22% to 55% for women at a specificity level of 95%.
This approach can substantially enhance the utility of the ECG for the detection of left ventricular hypertrophy. If these results are validated in other population groups, this approach may prove valuable in the screening of hypertensive populations and for the monitoring of patients undergoing treatment for hypertension.
本研究旨在利用弗雷明汉数据库设计并测试一种用于检测左心室肥厚的心电图（ECG）电压标准的改进方法，该方法具有性别特异性，并针对年龄和肥胖进行了调整。
心电图检测左心室肥厚受到越来越多的关注。“康奈尔”心电图电压，定义为aVL导联R波电压与V3导联S波电压之和，已被证明与超声心动图估计的左心室质量密切相关。由于该电压的大小随年龄和肥胖而变化，我们提出了一个针对这两个变量进行调整的简单公式。
采用线性回归，从弗雷明汉心脏研究队列中1468名男性和1883名女性的数据估计调整公式，这些人无心肌梗死，且在同一次临床检查中同时记录了心电图和超声心动图。使用改良的受试者工作特征曲线方法比较相同特异性水平下的敏感性。调整公式从研究队列中随机选择的一半数据估计得出，并应用于另一半数据进行评估。
在所有特异性水平上，检测左心室肥厚的敏感性均有显著提高。在特异性水平为98%时，调整使男性康奈尔电压的敏感性从10%提高到17%，女性从12%提高到22%。对于定义为左心室质量高于性别特异性平均值3个标准差的严重肥厚，在特异性水平为95%时，男性的敏感性从23%提高到38%，女性从22%提高到55%。
这种方法可以显著提高心电图检测左心室肥厚的效用。如果这些结果在其他人群中得到验证，这种方法可能在高血压人群的筛查和高血压治疗患者的监测中具有重要价值。
