新的心电图诊断标准RLⅠ＋SV4和SD＋SV4对高血压合并左心室肥厚的诊断价值

目的]观察新的心电图诊断标准RLⅠ＋SV4、SD＋SV4是否适用于高血压合并左心室肥厚(LVH)的诊断,研究13项心电图诊断标准以及新标准与常用标准联合应用对于高血压合并LVH的临床价值。[方法]以超声心动图测定的左心室质量指数(LVMI)为标准,选取原发性高血压或者有高血压治疗史的住院患者280例,其中高血压合并LVH患者94例(LVH组),左心室正常患者186例(左心室正常组)。同步记录12导联心电图。绘制各种心电图诊断标准的受试者工作特征曲线(ROC),比较ROC的曲线下面积(AUC)。计算各种诊断标准的灵敏度和特异度。分析RLⅠ＋SV4、SD＋SV4及其联合目前公认的心电图诊断LVH标准对高血压患者合并LVH的诊断价值。[结果]单个心电图导联中,RLⅠ即Ⅰ导联的R波是较好预测LVH的因子之一(AUC＝0.63,P＜0.01)。两个导联振幅相加诊断LVH的研究中,RLⅠ＋SV4标准(AUC＝0.64,P＜0.01)的灵敏度为50%,特异度为71%;配对卡方检验显示RLⅠ＋SV4诊断LVH与金标准(LVMI判定LVH)之间无明显统计学差异。SD＋SV4标准(AUC＝0.59,P＜0.05)的灵敏度为31%,特异度为87%,其中SD波为12导联中拥有最大振幅的S波。RLⅠ＋SV4联合Sokolow-Lyon电压标准能够提高诊断高血压合并LVH的灵敏度,其灵敏度为59%,特异度为60%。[结论]RLⅠ＋SV4标准具有较高的AUC,适合高血压患者合并LVH的初步筛查;RLⅠ＋SV4联合Sokolow-Lyon电压标准能够提高诊断的灵敏度。SD＋SV4标准临床适用性没有RLⅠ＋SV4标准高。     

心电图诊断老年男性左心室肥厚的价值

目的 探讨心电图诊断老年男性左心室肥厚的价值.方法 回顾性分析我院自1990年进行尸体解剖的老年男性患者资料,排除心电图QRS波时限≥10.12 s及起搏心电图的患者,测量死亡前3个月内标准12导联心电图QRS波振幅,分析老年男性不同年龄组心电图QRS波振幅与左心室前壁厚度的相关性.结果 心电图V5、V6、I、aVL导联R波幅度[分别为(1.1±0.7)mV、(0.9±0.6)mV、(0.4±0.3)mV和(0.3±0.3)mV]及心电图左胸导联(V5或V6)R波幅度与右胸导联(V1)S波幅度之和[(1.9±1.2)mV)与左心室前壁厚度[(13.6±5.4)mm]具有相关性(相关系数分别为0.22、0.14、0.22、0.23、0.23;P均<0.05).心电图左胸导联(V5或V6)R波幅度与右胸导联(V1)S波幅度之和与左心室前壁厚度的相关性60～79岁组最强(相关系数为0.48,P<0.01),80～89岁组二者相关性减弱(相关系数为0.23,P<0.05),而90～101岁组二者无相关性(相关系数为0.03,P>0.05).结论 心电图左心室肥厚诊断标准在90岁以下老年男性中具有可靠性.     

S_(aVR)与R_(aVL)+S_(V_3)标准诊断左室肥大的价值

目的探讨SaVR与RaVL+SV3电压标准诊断左室肥大(LVH)的价值。方法以超声心动图结果为诊断标准,测量有LVH者100例(A组)及无LVH者100例(B组)的心电图(ECG)SaVR和RaVL+SV3电压。计算B组SaVR和RaVL+SV3电压的均数及标准差,获取诊断LVH的ECG新标准,并与传统标准比较,检验不同标准对诊断LVH的敏感度、特异度及准确度。结果①SaVR诊断LVH的灵敏度低(36%),特异度高(100%),准确度为68%;传统标准及RaVL+SV3诊断LVH的灵敏度提高(52%及58%),但特异度明显下降(70%及84%),准确度60%及71%。②两者联用诊断LVH的灵敏度及准确度提高,特异度无明显降低,分别为68%、76%、84%;③两者联用对诊断LVH伴电轴左偏者的灵敏度显著提高,为77.9%,准确度与特异度相近,分别为78.8%、82.3%;④两者联用在成人各年龄组中及不同体型中诊断LVH的价值无差异。结论SaVR及RaVL+SV3标准诊断LVH具有临床实用价值,两者联用则更为理想,可弥补单用的不足。     

12导联心电图QRS总振幅正常值及对左心室肥大诊断标准的研究(摘要)

本文对1000例正常人、300例左心室肥大(LVH)12导联心电图QRS总振幅(∑QRS)进行了观察,结果正常人∑QRS95％正常值范围(均值±1.96倍标准差)男下限85mm、上限185mm,女下限75mm、上限175mm。以男∑QRS>185mm、女∑QRS>175mm为诊断LVH的标准,并与传统的胸导联电压标准、RE记分标准、黄大显等修改后记分标准进行对照,     

中国人群心电图幅度参数的年龄趋势和性别差异的调查

调查中国人群心电图QRS波幅度参数的年龄趋势和性别差异。采集 5 36 0例 (男 36 14例、女 174 6例 ,年龄范围 18～ 84岁 )健康人 12导联心电图并按性别分为 5个年龄组 ,计算和分析各年龄组男、女R波振幅 ,Sokolow指数(SV1+RV5)和Cornell指数 (RaVL+SV3 )的中位数及 96 %范围的正常上、下限。结果 :Ⅰ和aVL导联的R波振幅随年龄增长显著增加 (P <0 .0 0 1) ,而下壁导联Ⅱ、Ⅲ和aVF的R波振幅随年龄增长一致性地显著降低 (P <0 .0 0 1)。肢体导联R波振幅随年龄的变化与额面QRS电轴随年龄增长逐渐向左 (上 )偏移相一致。在胸导联 ,女性V5导联的R波振幅随年龄增长而增加 ;而男性Sokolow指数随年龄增长而降低。男、女的幅度差别在年轻的人群最为显著 ,随年龄增长这种差别趋向减小。男性Sokolow指数和Cornell指数在各年龄组均显著大于女性 (P <0 .0 0 1)。结论 :心电图幅度参数存在显著的年龄趋势和性别差异 ,确有必要建立与年龄和性别相关的正常值和诊断标准。     

镜像右位心的F导联心电图特征读析

目的 探讨F导联心电图诊断镜像右位心的特征。方法 在健康体检中应用F导联采集镜像右位心心电图并解读。结果 F导联检测到13例(0.018%)镜像右位心。在镜像右位心中Ⅰ导联各波形态均倒置,即P、QRS及T波均倒置;F2(Ⅱ)与F6(Ⅲ)导联、F3(aVR)与F1(aVL)导联波形互换;V3R、V5R导联波形类似正常时的V3、V5导联,代表左室波形;V1和V2导联代表右室波形。结论 镜像右位心的特征显示:P波F1(aVL)、F2(Ⅰ)导联显示镜像QRS波形;F1(aVL)、F2(Ⅰ)、F3(-aVR)、F4(Ⅱ)导联P-QRS-T波群均主波向下,呈rS型,其R波波幅递增;QRS波F5(aVF)不变;胸导联V1～V6呈rS型,其R波波幅递减,其S波呈逐渐相对增深,R/S比例逐渐减小的规律;V1导联R波高尖;常伴有其他心电图改变。     

右室流出道不同部位起搏体表心电图的形态特征研究

右室流出道 (RVOT)是一个相对较大的区域 ,事先定位这一区域内心律失常的起源部位有助于指导射频消融治疗。为评估根据体表 1 2导联心电图定位起源于RVOT不同部位的心律失常 ,选择 90例无器质性心脏病的室上性心动过速患者 (57例房室折返性心动过速、33例房室结折返性心动过速 )进行研究。将RVOT分为游离壁和间隔 ,按距肺动脉瓣的距离由近至远再分上、中、下三部 ,共 6个区。成功进行射频消融后 ,于RVOT不同部位进行起搏 ,并同时记录 1 2导联体表心电图。结果 :在间隔和游离壁起搏时 ,Ⅰ、aVL导联表现为特征性变化。间隔部起搏时Ⅰ导联QRS波形态多变 ,aVL导联QRS波主要呈QS型 ,QRSⅠ/QRSaVL<1 ;在游离壁起搏时 ,Ⅰ导联QRS波主要呈R型 ,aVL导联QRS波形态多变 ,QRSⅠ/QRSaVL>1。Ⅰ、aVL导联QRS波形态特征对判断游离壁和间隔具有较高的特异度和灵敏度。在RVOT上、中、下位起搏时 ,V3导联呈特征性变化 ,分别主要呈R、RS(R/S >1 )、rS(r/S <1 )型。V3导联QRS波形态特征对判断RVOT的上、中、下位具有较高的特异度和灵敏度。结论 :可根据体表心电图图形特征 ,定位RVOT起源的心律失常部位     

镜像右位心心室起搏伴1∶1 房室逆传

患者,男,59岁,临床诊断为病态窦房结综合征(SSS),右位心。8年前置入VVI起搏器,近日自觉胸闷来院就诊。常规导联心电图未见明显窦性P波,基本心律为心室起搏心律,HR60次/min,在起搏脉冲信号后继以宽大畸形的QRS波,其后有一相关的逆行P'波,R P'固定为0.22s,未见P'波下传心室,Ⅰ、Ⅱ、Ⅲ、aVF导联QRS波主波向下,SⅡ>SⅢ;aVR、aVL导联QRS波主波向上,RaVR>RaVL;V1～6导联QRS波主波均向下。左右手反接及右胸导联心电图(图1)示Ⅰ导联QRS波主波向上,Ⅱ、Ⅲ、aVF导联QRS波主波向下,SⅡ相似文献   

aVR导联的振幅与心衰预警

Madias的研究表明,12导联QRS波振幅之和(∑QRS)与体重的变化呈负相关:28例患者的平均体重从67.6kg增加到86.9kg时,∑QRS从120.2±41.6mV下降到54.8±26.9mV(p=0.0005)。体重与体表心电图关系的进一步研究发现,体重与胸导联V1￣V6导联的∑QRS相关性差,而与肢导、尤其是I和Ⅱ导联QRS波振幅明显相关。根据Kirchff’s第二电压理论:aVR=(I+Ⅱ)×1/2(右图),故单凭aVR导联QRS波振幅的变化则可监测患者体液潴留的动态改变。心衰患者心衰加     

判断急性下壁心肌梗死罪犯血管的心电学新标准

为验证心电图aVL导联QRS波群变化能否作为下壁急性心肌梗死 (AMI)罪犯血管的判定标准 ,比较 6 0例下壁AMI患者aVL导联QRS波群变化与冠状动脉造影结果的相关性 ,分析aVL导联QRS波群两种模式 (Ⅰ型 :S/R≤1/ 3,ST段抬高≤ 1mm ;Ⅱ型 :S/R >1/ 3,ST段抬高 >1mm)对判断下壁AMI罪犯血管的临床价值。结果 :aVL导联的Ⅰ型QRS波群改变在左冠状动脉回旋支闭塞 (LCX)组出现率为 89% ,右冠状动脉闭塞组为 2 4% (P <0 .0 0 1)。Ⅱ型改变在LCX组出现率为 11%、RCA组为 76 % (P <0 .0 0 1)。Ⅰ型心电图变化预测LCX闭塞的敏感度为 89%、特异性为 76 %。Ⅱ型心电图改变预测RCA闭塞的敏感度为 76 %、特异性为 89%。结论 :aVL导联的Ⅰ型QRS波群变化是判断LCX型AMI敏感、特异的预测指标 ,而Ⅱ型QRS波群变化是RCA型AMI有效的预测指标     

体位变化对QRS波形态的影响

目的探讨体表心电图（ECG）、动态心电图（DCG）不同体位对QRS波形态的影响。方法 40例接受ECG及95例接受DCG检查者分别进行卧位、立位心电图描记,每例2种ECG描记于5min内完成。结果 ECG：肢体导联：RaVR、SⅠ,胸导联：RV2～5、SV1、V3～6波形差异有显著性（P〈0.05）。DCG：肢体导联：QⅢ、aVR、aVL、RⅠ、Ⅱ、Ⅲ、aVL、SⅠ,aVR、aVF;胸导联：RV3～5、SV1～3波形差异有显著性（P〈0.05）。结论不论ECG还是DCG记录,卧位、立位记录的QRS波存在显著差异,DCG的肢体导联QRS波变化较ECG显著。     

Performance of classic electrocardiographic criteria for left ventricular hypertrophy in an African population

ECG criteria for left ventricular hypertrophy (LVH) have been almost exclusively elaborated and calibrated in white populations. Because several interethnic differences in ECG characteristics have been found, the applicability of these criteria to African individuals remains to be demonstrated. We therefore investigated the performance of classic ECG criteria for LVH detection in an African population. Digitized 12-lead ECG tracings were obtained from 334 African individuals randomly selected from the general population of the Republic of Seychelles (Indian Ocean). Left ventricular mass was calculated with M-mode echocardiography and indexed to body height. LVH was defined by taking the 95th percentile of body height-indexed LVM values in a reference subgroup. In the entire study sample, 16 men and 15 women (prevalence 9.3%) were finally declared to have LVH, of whom 9 were of the reference subgroup. Sensitivity, specificity, accuracy, and positive and negative predictive values for LVH were calculated for 9 classic ECG criteria, and receiver operating characteristic curves were computed. We also generated a new composite time-voltage criterion with stepwise multiple linear regression: weighted time-voltage criterion=(0.2366R(aVL)+0.0551R(V5)+0.0785S(V3)+ 0.2993T(V1))xQRS duration. The Sokolow-Lyon criterion reached the highest sensitivity (61%) and the R(aVL) voltage criterion reached the highest specificity (97%) when evaluated at their traditional partition value. However, at a fixed specificity of 95%, the sensitivity of these 10 criteria ranged from 16% to 32%. Best accuracy was obtained with the R(aVL) voltage criterion and the new composite time-voltage criterion (89% for both). Positive and negative predictive values varied considerably depending on the concomitant presence of 3 clinical risk factors for LVH (hypertension, age >/=50 years, overweight). Median positive and negative predictive values of the 10 ECG criteria were 15% and 95%, respectively, for subjects with none or 1 of these risk factors compared with 63% and 76% for subjects with all of them. In conclusion, the performance of classic ECG criteria for LVH detection was largely disparate and appeared to be lower in this population of East African origin than in white subjects. A newly generated composite time-voltage criterion might provide improved performance. The predictive value of ECG criteria for LVH was considerably enhanced with the integration of information on concomitant clinical risk factors for LVH.     

Effect of sex on informative power of various electrocardiographical criteria of left ventricular hypertrophy in patients with excessive body mass

Aim of the study was to analyze dependence of various voltage parameters of QRS complex on increase of left ventricular myocardial mass (LVMM) in samples of men and women with excessive body mass or obesity. We included data from 223 patients with excessive body mass and diagnosis of stage I - II arterial hypertension. ECG was registered in 12 standard leads. Left ventricular hypertrophy (LVH) was certified if according to echoCG data LVMM exceeded 125 g/m2 in men and 110 g/m2 in women. Depending on sex and presence of LVH all patients were divided into 4 groups: M1 (men with LVH, n=74), M2 (men without LVH, n=74), W1 (women with LVH, n=55), anb W2 (women without LVH, n=20). We analyzed amplitudes of all waves of the QRS complex as well as Sokolow-Lyons voltage parameters and the Cornell index. The following intergroup differences were most significant: between groups M1 and M2 - in amplitudes of S waves in chest leads V3, V4; between groups W1 and W2 - in amplitudes of R-waves in limb leads I and aVL, and amplitudes of S-waves in lead III. Increases of the Cornell voltage index were observed both in men and women with LVH. The following criteria had greatest sensitivity at 95% specificity: in men - SV4 > 1,1 mV (34%) and RaVL+SV3 > 2,3 mV (32%); in women - RaVL > 0,8 mV (56%) and RI+SIII > 1,5 mV (56%). Informative power of electrocardiographical diagnosis of LVH can be augmented by the use of different voltage criteria in groups of men and women. In men most informative are chest leads (SV1 - V3, RaVL) while in women - limb leads (RI, RaVL, and SIII). The use of combination parameters RaVL+SV3 > 2,3 mV (in men) and RI+SIII > 1,5 mV (in women) allows to augment sensitivity with unchanged specificity. In patients with excessive body mass voltage the Sokolow-Lyons criterion is not informative. Most significant component of the Cornell voltage criterion in groups of men with excessive body mass is amplitude of SV3, in groups of women - amplitude of RaVL.     

Effect of Right Bundle Branch Block on Electrocardiographic Amplitudes,Including Combined Voltage Criteria Used for the Detection of Left Ventricular Hypertrophy

Background: Although right bundle branch block (RBBB) delays right ventricular depolarization, its effect on cancellation of right and left ventricular forces within the QRS complex has not been quantified during stable temporal and physiological conditions. Systematic changes in QRS amplitude during transient RBBB bear directly on performance of standard ECG criteria for left ventricular hypertrophy (LVH), and these changes require quantification. Methods: We examined the instantaneous effect of RBBB on QRS amplitudes and LVH voltages in 40 patients who had intermittent complete RBBB during a single 10 sec standard 12‐lead ECG recording, comprising 0.1% of approximately 400,000 consecutive ECGs in a university teaching hospital setting. Amplitudes were measured by magnifying graticule to the nearest 25 microvolts, averaged for up to 3 normal and 3 RBBB complexes, and compared by paired t test. Results: RBBB was associated with an increase in initial QRS forces (RV1, RV2, and QV6) but significant decreases in mean mid‐QRS amplitudes that reflect left ventricular depolarization (RaVL [−75 microvolts], SV1 [−389 microvolts], SV3 [−617 microvolts], RV5 [−100 microvolts], and RV6 [−123 microvolts]). All late QRS forces were increased with RBBB (R'V1, SV5, SI). As a result, combined voltages used for LVH criteria were significantly reduced by RBBB: Sokolow‐Lyon voltage decreased from 1520 ± 739 to 1014 ± 512 microvolts (p < 0.001) , and Cornell voltage decreased from 1438 ± 683 to 746 ± 399 microvolts (p < 0.001) . Conclusions: RBBB is associated with significant reduction in "left ventricular" QRS amplitudes of the standard ECG, consistent with cancellation, rather than unmasking, of left ventricular mid‐QRS forces by altered septal and delayed right ventricular depolarization. Because QRS voltages that are routinely combined for the detection of LVH are reduced in RBBB, standard LVH criteria will perform with lower sensitivity in patients with RBBB.     

肥厚型心肌病体表心电图特征

目的 探讨肥厚型心肌病（HCM）患者体表心电图（ECG）特征。 方法 选取2015年5月~2017年4月期间住院治疗的HCM患者60例，同时选取本院同期查体的正常人60例，作为对照组，要求两组人员性别、年龄、体质量指数匹配。分析ECG各导联QRS波时限和R波、S波振幅，异常q波情况，QTC时限，R/S比值， ST段下移与抬高，T波低平、倒置，P波时限等指标。 结果 ①HCM组的V2、V3导联QRS波时限；Ⅱ、V4导联异常Q波比例；QTC时限；P波时限；左心室肥厚ECG诊断公式SV1+RV5/V6及（SV3+RaVL）×QRS波时限均显著高于正常对照组。②HCM组的I、aVR、aVL、aVF导联QRS波时限；aVR导联Q波所占比例； I、Ⅱ、Ⅲ、aVL、aVF、V3、V4、V5、V6导联QRS波主波与T波方向一致性； V4、V5、V6导联R/S比值均显著低于正常对照组。 结论 ECG诊断HCM首先要满足左心室肥厚的诊断标准，再结合上述ECG导联的特异性参数进行综合判断。     

Complete left branch block and electrocardiographic diagnosis of left ventricular hypertrophy

The electrocardiogrammes of 71 patients (39 men and 32 women) with transient or intermittent complete left bundle branch block (LBBB) were studied. Two tracings, one with and the other without LBBB were analysed in each case. The interval between the two recordings was less than 90 days in all cases (average 10 days). The diagnosis of left ventricular hypertrophy (LVH) was established from the ECG without LBBB. The sensitivity and specificity of the classical criteria or indices of LVA and of different associations of indices of LVH were assessed on the ECGs with LBBB. The best criteria of LVH in the presence of LBBB were the SV2 + RV6 greater than or equal to 32 mm (sensitivity 80%; specificity 81%), Sokolow's index greater than or equal to 33 mm (sensitivity 78%, specificity 81%); followed by SV1 greater than or equal to 23 mm (sensitivity 73%, specificity 86%), SV1 + SV2 + RV6 + RV7 greater than or equal to 65 mm (sensitivity 88%, specificity 63%), SV1 + SV2 greater than or equal to 54 mm (sensitivity 73%, specificity 74%). These six parameters allow correct diagnosis of LVH in 81%, 79%, 78%, 79% and 73% of cases, respectively. The SV1 + SV2 + RV5 + RV7 and the SV1 + SV2 + RV6 + RV7 greater than or equal to 65 mm indices are the most stable (same sensitivity and specificity for several consecutive threshold values, i.e. 62 to 67 mm and 64 to 66 mm respectively); the results obtained with these two indices are therefore more likely to be reproducible than those of the other indices as they seem less dependent on the sampling. The indices of LVH based on the QRS amplitude in the precordial leads remain valid in the presence of LBBB and are sufficiently reliable for the diagnosis of LVH to be clinically useful.     

Determination of left ventricular wall thickening in patients with chronic systemic hypertension. Correlation of electrocardiography and echocardiography.

M-mode echocardiography was performed in 81 patients with chronic arterial hypertension in order to determine the specificity and sensitivity of the various ECG criteria used for diagnosing left ventricular hypertrophy (LVH) in the determination of left ventricular wall thickening (LVWT). Fifteen popular ECG criteria were studied and showed to be highly specific for LVWT (90 percent to 100 percent). TV1 greater than TV6, RV8 greater than 20 mm and SV1 + Rmax V5 or V6 greater than 35 mm were the most sensitive criteria (69 percent, 54 percent, and 52 percent respectively). The popular limb lead criteria for LVH were less sensitive than the precordial lead criteria in the determination of LVWT. The Estes point system, although less sensitive than some of the other voltage criteria, showed an absolute specificity for LVWT. The ST segment deviation with strain pattern was found in 46 percent of patients with LVWT. An isolated ST segment deviation without any other voltage criterion reflected at most only mild wall thickening. Six patients with LVWT had normal ECG; all of them were categorized in the mild LVWT group. Left axis deviation was found to be a poor indicator of wall thickening in uncomplicated hypertensive patients.