Okin P M, Roman M J, Devereux R B, Kligfield P
Department of Medicine, New York Hospital-Cornell Medical Center, New York, NY 10021, USA.
Hypertension. 1996 Feb;27(2):251-8. doi: 10.1161/01.hyp.27.2.251.
Standard electrocardiographic criteria have exhibited poor sensitivity for left ventricular hypertrophy at acceptable levels of specificity and perform less well in women than men, even when sex-specific criteria are used. The time-voltage integral of the horizontal plane vector QRS complex can improve identification of hypertrophy in men, but performance of this approach in women and the effect of sex-specific criteria on accuracy have not been examined. To evaluate the accuracy of the time-voltage integral of the QRS complex for the identification of left ventricular hypertrophy in women and to examine the effect of sex-and non-sex-specific criteria on test performance, we obtained standard 12-lead and orthogonal-lead signal-averaged electrocardiograms and echocardiograms in 175 control subjects without hypertrophy (43 women and 132 men) and 75 patients with hypertrophy (26 women and 49 men) defined by echocardiographic criteria (indexed left ventricular mass > 110 g/m2 in women and > 125 g/m2 in men). Voltage of the QRS complex was integrated over the total QRS duration in leads X and Z for calculation of the time-voltage integral of the horizontal plane vector complex. With the use of a partition of 99.2 microV.s with a specificity of 98% in the entire normal group, sensitivity of the horizontal plane vector integral was significantly lower in women than men (31% versus 71%, P < .001). In contrast, use of sex-specific partitions of 75.4 microV.s in women and 99.2 microV.s in men with matched 98% specificity significantly improved sensitivity in women to 81% (P < .001), with no change in sensitivity in men (71%). Comparison of receiver operating characteristic curves with the use of sex-specific criteria demonstrated no significant difference in overall performance of the horizontal plane vector integral between men and women. The 81% and 71% sensitivities of the sex-specific horizontal plane vector integral were significantly greater than the 27% to 58% sensitivities of sex-specific 12-lead electrocardiographic criteria in this population. Thus, sex-specific criteria significantly improve performance of the time-voltage integral of the QRS for the identification of left ventricular hypertrophy in women, with no loss of accuracy in men. Use of the time-voltage integral can improve the accuracy of the electrocardiogram for the identification of left ventricular hypertrophy in both women and men.
标准心电图标准在具有可接受特异性水平时对左心室肥厚的敏感性较差，而且在女性中的表现不如男性，即使使用了性别特异性标准也是如此。水平面QRS波群向量的时间电压积分可以提高男性肥厚的识别率，但该方法在女性中的表现以及性别特异性标准对准确性的影响尚未得到研究。为了评估QRS波群时间电压积分对识别女性左心室肥厚的准确性，并研究性别特异性和非性别特异性标准对检测性能的影响，我们获取了175名无肥厚对照受试者（43名女性和132名男性）和75名经超声心动图标准定义为肥厚的患者（26名女性和49名男性）的标准12导联和正交导联信号平均心电图及超声心动图（女性左心室质量指数>110 g/m2，男性>125 g/m2）。计算X和Z导联中QRS波群在整个QRS波持续时间内的电压积分，以得出水平面向量复合波的时间电压积分。在整个正常组中使用特异性为98%的99.2 μV·s的分割值时，水平面向量积分在女性中的敏感性显著低于男性（31%对71%，P<.001）。相比之下，使用女性75.4 μV·s和男性99.2 μV·s的性别特异性分割值且特异性匹配为98%时，女性的敏感性显著提高至81%（P<.001），而男性的敏感性无变化（71%）。使用性别特异性标准比较受试者工作特征曲线表明，男性和女性之间水平面向量积分的总体性能无显著差异。在该人群中，性别特异性水平面向量积分的81%和71%的敏感性显著高于性别特异性12导联心电图标准的27%至58%的敏感性。因此，性别特异性标准显著提高了QRS波时间电压积分对识别女性左心室肥厚的性能，且男性的准确性没有损失。使用时间电压积分可以提高心电图对识别男性和女性左心室肥厚的准确性。
