Heller J, Hagège A A, Besse B, Desnos M, Marie F N, Guerot C
Cardiology Department, Boucicaut Hospital, Necker-Enfants Malades, Faculty of Medicine, Paris, France.
J Am Coll Cardiol. 1996 Mar 15;27(4):877-82. doi: 10.1016/0735-1097(95)00554-4.
This study sought to determine the clinical significance of a "crochetage" pattern--a notch near the apex of the R wave in electrocardiographic (ECG) inferior limb leads--in secundum atrial septal defect.
Atrial septal defect is often overdiagnosed on the basis of classical clinical features. Thus, more specific signs on the ECG for screening are needed. Methods. We searched for a crochetage pattern in 1,560 older children and adults: 532 with secundum atrial septal defect, 266 with ventricular septal defect, 146 with pulmonary stenosis, 110 with mitral stenosis, 47 with cor pulmonale and 459 normal subjects.
This pattern was observed respectively in 73.1%, 35.7%, 23.3%, 6.4%, 10.6% and 7.4% of these groups (p<0.001). In atrial septal defect, its incidence increased with larger anatomic defect (p<0.0001) or greater left-to-right shunt (p<0.0001), even in the presence of pulmonary hypertension. By multiple regression analysis, only shunt size (p<0.0006) and defect location (p<0.0001) were the determinants of its presence. In all groups, the specificity of this sign for the diagnosis was remarkably high when present in all three inferior limb leads (> or = to 92%), even when comparison was limited to patients with an incomplete right bundle branch block (> or = 95.2%). Early disappearance of this pattern was observed in 35.1% of the operated-on patients although the right bundle branch block pattern persisted.
A crochetage pattern of the R wave in inferior limb leads is frequent in patients with atrial septal defect, correlates with shunt severity and is independent of the right bundle branch block pattern. Sensitivity and specificity of this sign are remarkably high when it is associated with an incomplete right bundle branch block or present in all inferior limb leads.
本研究旨在确定心电图（ECG）下肢导联R波顶点附近的切迹——“钩编样”图形在继发孔型房间隔缺损中的临床意义。
房间隔缺损常基于典型临床特征被过度诊断。因此，需要心电图上更具特异性的筛查体征。方法。我们在1560名大龄儿童和成人中寻找钩编样图形：532例继发孔型房间隔缺损患者、266例室间隔缺损患者、146例肺动脉狭窄患者、110例二尖瓣狭窄患者、47例肺心病患者和459名正常受试者。
该图形在这些组中的出现率分别为73.1%、35.7%、23.3%、6.4%、10.6%和7.4%（p<0.001）。在房间隔缺损中，其发生率随解剖缺损增大（p<0.0001）或左向右分流增加（p<0.0001）而升高，即使存在肺动脉高压。通过多元回归分析，只有分流大小（p<0.0006）和缺损位置（p<0.0001）是其出现的决定因素。在所有组中，当该体征出现在所有三个下肢导联时（≥92%），其诊断特异性非常高，即使仅与不完全性右束支传导阻滞患者比较时（≥95.2%）也是如此。尽管右束支传导阻滞图形持续存在，但在35.1%的手术患者中观察到该图形早期消失。
下肢导联R波的钩编样图形在房间隔缺损患者中常见，与分流严重程度相关且独立于右束支传导阻滞图形。当该体征与不完全性右束支传导阻滞相关或出现在所有下肢导联时，其敏感性和特异性非常高。
