Okin P M, Roman M J, Devereux R B, Kligfield P
Department of Medicine, New York Hospital-Cornell Medical Center, New York 10021, USA.
J Am Coll Cardiol. 1996 Jan;27(1):124-31. doi: 10.1016/0735-1097(95)00421-1.
This study sought to assess a test performance of the electrocardiogram (ECG) in relation to 1) varying definitions of left ventricular hypertrophy based on different methods of adjusting left ventricular mass for body size, and 2) the presence or absence of obesity.
Although left ventricular mass is most commonly indexed for body surface area or height when defining left ventricular hypertrophy, recent work suggests that normalization for height to the power of 2.7 (height2.7) may decrease variability among normal subjects and correctly identify the impact of obesity on hypertrophy.
The product of Cornell voltage and QRS duration (Cornell product) and Framingham-adjusted Cornell voltage were determined from 12-lead ECGs in 212 patients. Left ventricular hypertrophy was defined on the basis of left ventricular mass indexed to body surface area, height and height2.7.
Using partitions with matched specificity of 95%, the sensitivity of ECG criteria varied with the definition of hypertrophy, ranging from 39% to 52% for the Cornell product and from 24% to 33% for adjusted Cornell voltage. When left ventricular mass was indexed to body surface area or to height2.7, the 52% and 39% sensitivities of the Cornell product were significantly greater than the 24% (p < 0.001) and 29% (p < 0.05) sensitivities of adjusted Cornell voltage, with a similar trend when left ventricular mass was indexed to height (43% vs. 33%, p = 0.10). Comparison of receiver operating characteristic curves confirmed the superior overall performance of the Cornell product relative to adjusted Cornell voltage for hypertrophy defined by body surface area and height2.7 and demonstrated greater reproducibility of overall performance, as measured by the coefficient of variability, for the Cornell product (1.7%) than for adjusted Cornell voltage (5.8%). Sensitivity of adjusted Cornell voltage was significantly greater in obese than in nonobese subjects (50% to 59% vs. 18% to 24%, p < 0.01), but the Cornell product had only minimally higher sensitivity in nonobese than in obese subjects (40% to 54% vs. 32% to 44%, p = NS).
The ability of ECG criteria to detect left ventricular hypertrophy differs depending on the method of indexing left ventricular mass for body size and with the presence or absence of obesity. Further, the Cornell product provides the best combination of overall accuracy and low variability of performance between definitions of hypertrophy. These findings have important implications for the clinical and epidemiologic use of 12-lead ECG criteria for the detection of left ventricular hypertrophy.
本研究旨在评估心电图（ECG）在以下方面的检测性能：1）基于不同的左心室质量校正方法对身体大小的不同左心室肥厚定义；2）肥胖的存在与否。
虽然在定义左心室肥厚时，左心室质量最常根据体表面积或身高进行指数化，但最近的研究表明，将身高校正为2.7次幂（身高2.7）可能会降低正常受试者之间的变异性，并正确识别肥胖对肥厚的影响。
从212例患者的12导联心电图中确定康奈尔电压与QRS波时限的乘积（康奈尔乘积）以及经弗雷明汉校正的康奈尔电压。根据左心室质量相对于体表面积、身高和身高2.7的指数来定义左心室肥厚。
使用特异性匹配为95%的划分，ECG标准的敏感性随肥厚定义的不同而变化，康奈尔乘积的敏感性范围为39%至52%，经校正的康奈尔电压的敏感性范围为24%至33%。当左心室质量相对于体表面积或身高2.7进行指数化时，康奈尔乘积的52%和39%的敏感性显著高于经校正的康奈尔电压的24%（p<0.001）和29%（p<0.05）的敏感性，当左心室质量相对于身高进行指数化时也有类似趋势（43%对33%，p = 0.10）。接受者操作特征曲线的比较证实，对于由体表面积和身高2.7定义的肥厚，康奈尔乘积相对于经校正的康奈尔电压具有更好的总体性能，并且通过变异系数测量，康奈尔乘积（1.7%）的总体性能再现性高于经校正的康奈尔电压（5.8%）。经校正的康奈尔电压在肥胖受试者中的敏感性显著高于非肥胖受试者（50%至59%对18%至24%，p<0.01），但康奈尔乘积在非肥胖受试者中的敏感性仅略高于肥胖受试者（40%至54%对32%至44%，p = 无统计学意义）。
ECG标准检测左心室肥厚的能力因左心室质量相对于身体大小的指数化方法以及肥胖的存在与否而有所不同。此外，康奈尔乘积在肥厚定义之间提供了总体准确性和性能低变异性的最佳组合。这些发现对12导联ECG标准在临床和流行病学中用于检测左心室肥厚具有重要意义。
