Tamama K, Kanda T, Osada M, Nagai R, Suzuki T, Kobayashi I
Department of Laboratory Medicine and Clinical Laboratory Center, Gunma University School of Medicine, Maebashi, Japan.
J Med. 1998;29(3-4):231-6.
Cardiomegaly is one of the commonest findings encountered in daily clinical practice, and its differential diagnosis is a common clinical problem. There are many electrocardiological (ECG) criteria known for left ventricular hypertrophy (LVH), but its limitations have also been suggested. We evaluated 102 patients fulfilling the ECG criteria of precordial and limb lead for LVH with echocardiographic findings as a gold standard. Among these 102 patients, the echocardiogram revealed 38 subjects with LVH, 26 subjects with left ventricular dilatation (LVD), 7 subjects with both findings, and 31 subjects with neither findings. Precordial criteria such as SV1+RV5 or RV6 > 30 mm, SV1 or SV2+RV5 > 35 mm, R+S > 40 mm, SV1 or SV2+RV5 or RV6 > 35 mm, SV2+RV4 or RV5 > 35 mm, high in sensitivity and low in specificity for LVD and LVH, are appropriate for screening LVD and LVH. Cornell limb lead criterion, SV3+RaVL > 28 mm (male), SV3+RaVL > 20 mm (female), high in sensitivity and specificity only for LVH, is the best elecrocardiographic criterion to evaluate LVH. Precordial and limb lead criteria such as R> 13 mm, RaVL > 12 mm, RaVF > 20 mm, onset of intrinsicoid deflection in V5 or V6> 0.05 sec, left axis deviation -30 degrees to -90 degrees, low in sensitivity, and high in specificity, are useful to rule out LVH and/or LVD. Our findings suggest LVD and LVH can be evaluated by ECG, but similar sensitivity and specificity for both LVH and LVD makes separation of LVH from LVD unattainable.
心脏肥大是日常临床实践中最常见的发现之一，其鉴别诊断是一个常见的临床问题。已知有许多用于诊断左心室肥厚（LVH）的心电图（ECG）标准，但也有人指出了其局限性。我们以超声心动图检查结果作为金标准，对102例符合胸前导联和肢体导联LVH心电图标准的患者进行了评估。在这102例患者中，超声心动图显示38例有LVH，26例有左心室扩张（LVD），7例两者均有，31例两者均无。胸前导联标准，如SV1 + RV5或RV6> 30 mm、SV1或SV2 + RV5> 35 mm、R + S> 40 mm、SV1或SV2 + RV5或RV6> 35 mm、SV2 + RV4或RV5> 35 mm，对LVD和LVH的敏感性高而特异性低，适用于LVD和LVH的筛查。康奈尔肢体导联标准，SV3 + RaVL> 28 mm（男性），SV3 + RaVL> 20 mm（女性），仅对LVH的敏感性和特异性高，是评估LVH的最佳心电图标准。胸前导联和肢体导联标准，如R> 13 mm、RaVL> 12 mm、RaVF> 20 mm、V5或V6导联的类本位曲折起始> 0.05秒、电轴左偏-30度至-90度，敏感性低而特异性高，有助于排除LVH和/或LVD。我们的研究结果表明，LVD和LVH可以通过心电图进行评估，但LVH和LVD的敏感性和特异性相似，使得无法将LVH与LVD区分开来。
