Schillaci G, Verdecchia P, Sacchi N, Vignai E, Benemio G, Porcellati C
Divisione di Medicina, Ospedale Beato G. Villa, Città della Pieve, PG, Perugia.
G Ital Cardiol. 1999 Jan;29(1):34-8.
Electrocardiography (ECG) has a lower sensitivity for the diagnosis of left ventricular (LV) hypertrophy in smokers than in non-smokers, but the explanation for this finding is not known. In the setting of the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study, all subjects smoking > or = 15 cigarettes/day (n = 121, 89 men, age 48 +/- 11 years) were selected from 1443 untreated hypertensive subjects undergoing ECG and M-mode echocardiography, and matched with 484 hypertensive non-smokers by gender (same sex), age (+/- 5 years), and systolic and diastolic blood pressure (both +/- 5 mmHg) in a case-to-control design with a 1:4 matching ratio. Smokers and non-smokers did not differ by age, gender, body mass index, and blood pressure. The voltage of SV1 + RV5 or V6 and RI (p < 0.05), but not of SV3 + RaVL, was lower in smokers. Sensitivity of ECG was lower in smokers when using peripheral or left precordial voltage criteria (e.g. 11 vs 26% for Sokolow-Lyon voltage). When using definitions based on different criteria (voltage of S wave in V3, LV axis, LV strain), sensitivity was not dissimilar in smokers and non-smokers (e.g. 19 vs 18% for Romhilt-Estes score, 40 vs 34% for Perugia criterion). Thus, in hypertensive smokers, sensitivity of ECG is lower than in non-smokers when using peripheral or left precordial voltage criteria, probably due to increased chest size in smokers resulting from increased lung compliance. For LV hypertrophy detection, Sokolow-Lyon voltage should be avoided in hypertensive smokers and replaced by other criteria (Cornell voltage, Romhilt-Estes score, Perugia criterion), which are not influenced by cigarette smoking.
心电图（ECG）对吸烟者左心室（LV）肥厚的诊断敏感性低于非吸烟者，但这一发现的原因尚不清楚。在翁布里亚高血压动态监测研究（PIUMA）中，从1443名接受心电图和M型超声心动图检查的未治疗高血压患者中选取了所有每天吸烟≥15支的受试者（n = 121，89名男性，年龄48±11岁），并按照病例对照设计，以1:4的匹配比例，根据性别（同性）、年龄（±5岁）以及收缩压和舒张压（均±5 mmHg）与484名高血压非吸烟者进行匹配。吸烟者和非吸烟者在年龄、性别、体重指数和血压方面无差异。吸烟者的SV1 + RV5或V6以及RI的电压较低（p < 0.05），但SV3 + RaVL的电压无差异。当使用外周或左胸前导联电压标准时，吸烟者心电图的敏感性较低（例如，Sokolow-Lyon电压标准下分别为11%和26%）。当使用基于不同标准（V3导联S波电压、左心室轴、左心室应变）的定义时，吸烟者和非吸烟者的敏感性无差异（例如，Romhilt-Estes评分分别为19%和18%，佩鲁贾标准分别为40%和34%）。因此，在高血压吸烟者中，当使用外周或左胸前导联电压标准时，心电图的敏感性低于非吸烟者，这可能是由于吸烟者肺顺应性增加导致胸廓增大所致。对于左心室肥厚的检测，高血压吸烟者应避免使用Sokolow-Lyon电压标准，而应采用其他不受吸烟影响的标准（康奈尔电压、Romhilt-Estes评分、佩鲁贾标准）。
