Okin P M, Roman M J, Devereux R B, Kligfield P
Department of Medicine, New York Hospital-Cornell Medical Center, NY 10021, USA.
J Electrocardiol. 1996;29 Suppl:256-61. doi: 10.1016/s0022-0736(96)80072-0.
Obesity is associated with the presence of left ventricular hypertrophy (LVH) and, conversely, with decreased sensitivity of the electrocardiogram (ECG) for LVH due to attenuating effects on QRS amplitudes. Although the Framingham-adjusted Cornell voltage, incorporating age, sex, and body mass index (BMI), was developed to correct for the effects of obesity on the accuracy of the ECG, the impact of body habitus on ECG detection of LVH for newer, more accurate ECG criteria based on the time-voltage area under the QRS complex has not been determined. The authors examined the test accuracy of the Sokolow-Lyon voltage, Cornell voltage, Cornell product (product of QRS duration and Cornell voltage), Framingham-adjusted Cornell voltage, and time-voltage area of the horizontal plane vector QRS for the detection of echocardiographic LVH in relation to body habitus in 250 patients. Normal-weight or overweight status was based on sex-specific population-based BMI partitions. Using partitions with a matched specificity of 98% in the overall population without LVH, the sensitivity of standard ECG criteria varied according to body habitus. Sensitivity of the Framingham-adjusted Cornell voltage was less in normal-weight than in overweight patients (49 vs 59%, P = .0004); there were also trends toward lower sensitivity in normal-weight patients for the Cornell voltage (40 vs 65%, P = .10) and the Cornell product (43 vs 65%, P = NS), but sensitivity of the Sokolow-Lyon voltage was lower in obese than in nonobese patients (18 vs 50%, P = .025). In contrast, the horizontal plane vector area had similar sensitivity in obese and normal-weight patients (76 vs 74%, P = NS). Specificity varied with body habitus only for the Framingham-adjusted Cornell voltage: 100% in normal-weight vs 95% in overweight patients (P < .05). Thus, accuracy of the Framingham-adjusted Cornell voltage and Sokolow-Lyon voltage varies significantly with body habitus. In contrast, accuracy of the Cornell voltage and the Cornell product appears less dependent on BMI, and the time-voltage area of the QRS minimizes the effects of obesity on the accuracy of the ECG for LVH.
肥胖与左心室肥厚（LVH）的存在相关，相反，由于对QRS波幅的衰减作用，肥胖会降低心电图（ECG）对LVH的敏感性。尽管纳入年龄、性别和体重指数（BMI）的弗明汉校正康奈尔电压是为了校正肥胖对ECG准确性的影响，但身体形态对基于QRS波群下时间-电压面积的更新的、更准确的ECG标准检测LVH的影响尚未确定。作者在250例患者中研究了索科洛-里昂电压、康奈尔电压、康奈尔乘积（QRS波持续时间与康奈尔电压的乘积）、弗明汉校正康奈尔电压以及水平面QRS向量的时间-电压面积检测超声心动图LVH相对于身体形态的检测准确性。正常体重或超重状态基于按性别划分的基于人群的BMI分区。在无LVH的总体人群中使用特异性匹配为98%的分区时，标准ECG标准的敏感性因身体形态而异。弗明汉校正康奈尔电压在正常体重患者中的敏感性低于超重患者（49%对59%，P = 0.0004）；正常体重患者中康奈尔电压（40%对65%，P = 0.10）和康奈尔乘积（43%对65%，P = 无显著性差异）的敏感性也有降低趋势，但索科洛-里昂电压在肥胖患者中的敏感性低于非肥胖患者（18%对50%，P = 0.025）。相比之下，水平面向量面积在肥胖和正常体重患者中的敏感性相似（76%对74%，P = 无显著性差异）。仅弗明汉校正康奈尔电压的特异性随身体形态而变化：正常体重患者中为100%，超重患者中为95%（P < 0.05）。因此，弗明汉校正康奈尔电压和索科洛-里昂电压的准确性随身体形态有显著变化。相比之下，康奈尔电压和康奈尔乘积的准确性似乎较少依赖于BMI，并且QRS波的时间-电压面积可将肥胖对LVH的ECG准确性的影响降至最低。
