在存在右束支传导阻滞的情况下，心电图显示的左心房异常可预测超声心动图显示的左心室肥厚。

Left atrial abnormality by electrocardiogram predicts left ventricular hypertrophy by echocardiography in the presence of right bundle-branch block.

作者信息

Mehta A, Jain A C, Morise A P, Mehta M C, Billie M

机构信息

Department of Medicine, West Virginia University School of Medicine, Morgantown 26506-9157, USA.

出版信息

Clin Cardiol. 1998 Feb;21(2):109-14. doi: 10.1002/clc.4960210209.

DOI:10.1002/clc.4960210209

PMID:9491950

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6655808/

Abstract

BACKGROUND

Left ventricular hypertrophy (LVH) on the electrocardiogram (ECG) may be masked in the presence of complete right bundle-branch block (RBBB). Left bundle-branch block on the ECG is associated with LVH at autopsy in 93% of hearts studied. However, RBBB does not predict LVH and the usual ECG criteria applied for LVH may not be reliable in the presence of RBBB.

HYPOTHESIS

The study was undertaken to evaluate left atrial (LA) abnormality as a criterion for the diagnosis of LVH in the presence of RBBB.

METHODS

Left atrial abnormality in the ECG was assessed by two independent observers as a criterion of LVH in the presence of RBBB in 100 patients, and data were compared with those of 50 patients without LA abnormality.

RESULTS

Left ventricular hypertrophy was confirmed by echocardiographic determination of left ventricular (LV) mass in both groups. Observers reliably differentiated between hypertrophied and normal-sized LV in the presence of RBBB by using LA abnormality as an ECG criterion when correlated with LV mass determined by echocardiography. Observer 1 correctly detected LVH in 88% and Observer 2 in 82% of patients. False positive diagnosis was made in 12 and 18% of patients by Observers 1 and 2, respectively. Observers' performance of recognition of LA abnormality in the present study was 94%. Results showed sensitivity of 76 and 70% and specificity of 84 and 92% for Observers 1 and 2, respectively. Left ventricular mass increased significantly and was diagnostic of LVH in 92% of patients with LA abnormality. Left ventricular mass was high in 84% of patients when corrected by body surface area. LVH in the presence of RBBB by the ECG was found in only seven patients (5%) when six commonly used conventional criteria of diagnosis of LVH by ECG were employed. Regression analysis found LA abnormality to be a strong independent predictor of increased LV mass. Multiple regression analysis revealed that age, body mass index, body surface area, and frontal axis are also significant predictors of LV mass.

CONCLUSION

The results obtained by the correlation of LA abnormality by ECG and LVH by echocardiography conclude that LA abnormality by ECG was significantly diagnostic of LV hypertrophy in the presence of RBBB.

摘要

背景

心电图（ECG）上的左心室肥厚（LVH）在存在完全性右束支传导阻滞（RBBB）时可能被掩盖。在研究的93%的心脏尸检中，心电图上的左束支传导阻滞与LVH相关。然而，RBBB并不能预测LVH，并且在存在RBBB时，用于诊断LVH的常规心电图标准可能不可靠。

假设

本研究旨在评估左心房（LA）异常作为RBBB存在时LVH诊断标准的价值。

方法

由两名独立观察者评估100例存在RBBB患者心电图上的左心房异常，以此作为LVH的诊断标准，并将数据与50例无LA异常的患者进行比较。

结果

两组均通过超声心动图测定左心室（LV）质量来确诊左心室肥厚。当与超声心动图测定的LV质量相关联时，观察者通过将LA异常作为心电图标准，在存在RBBB的情况下能够可靠地区分肥厚的LV和正常大小的LV。观察者1在88%的患者中正确检测出LVH，观察者2在82%的患者中正确检测出LVH。观察者1和观察者2分别在12%和18%的患者中做出了假阳性诊断。在本研究中，观察者识别LA异常的表现为94%。结果显示，观察者1的敏感性为76%，特异性为84%；观察者2的敏感性为70%，特异性为92%。在存在LA异常的患者中，92%的患者LV质量显著增加并可诊断为LVH。校正体表面积后，84%的患者LV质量较高。当采用六种常用的心电图诊断LVH的传统标准时，在存在RBBB的患者中，仅七例（5%）通过心电图发现LVH。回归分析发现LA异常是LV质量增加的强有力的独立预测因素。多元回归分析显示，年龄、体重指数、体表面积和额面电轴也是LV质量的重要预测因素。