高血压左心室肥厚的简易心电图电压标准

目的寻找心电图(ECG)诊断左心室肥厚(LVH)的较好电压标准.方法以高血压患者为研究对象,将目前ECG诊断LVH的各种电压标准与超声心动图左心室心肌重量(LVM)及左心室心肌重量指数(LVMI)进行统计分析比较.结果一项新的电压指标,即胸导联最大QRS电压(简称Vmax)与超声心动图LVMI相关最为密切(r=0.545,P<0.001).结论Vmax有希望成为ECG诊断LVH的有效实用的新指标.     

高血压左心室肥厚诊断指标的相关性研究

目的探讨超声心动图(Echocardiography,UCG)、心电图(Electrocardiogram,ECG)相关指标诊断高血压左心室肥厚(left ventricular hypertrophy,LVH)的关系。方法对295例高血压患者分别检测UCG的左心室重量(left ventricular weight,LVM)及左心室重量指数(left ventricular weight index,LVMI)、ECG的SoKolow-Lyon电压指数、Cornell电压指数及Cornell乘积指数。结果 UCG诊断高血压LVH检出率为39.66%,ECG诊断高血压LVH检出率为14.24%,两组比较差异有统计学意义(P<0.05)。诊断LVH时,UCG的指标LVMI明显优于ECG各相关指标,差异有统计学意义(χ2值分别为18.57、17.58、28.38,P<0.05)。ECG各诊断指标与UCG的LVMI及LVM呈正相关(P<0.05)。结论 UCG早期诊断高血压LVH较ECG敏感,且特异性高。     

ΣSv1～3加ΣRⅠ、Ⅱ、aVL电压对左心室肥厚的诊断价值

由于心电图 (ECG)传统电压标准诊断左心室肥厚 (LVH)的敏感性低 ,长期以来 ,许多研究不断探讨出新的标准〔1～ 3〕。本文以诊断LVH的超声心动图 (UCG)标准结果作为对照 ,采用张绪洪等〔2〕提出的电压新标准 ,并结合ST T及其他指标的改变 ,分析 2 83例患者的ECG ,并与传统标准比较 ,检验其对LVH的诊断价值。1　对象与方法1 .1 　 对象本院门诊及住院患者共 2 83例 ,男 1 69例 ,女1 1 4例 ,年龄 2 4～ 75 ( 4 7.3± 9.5 )岁。全部受检者在作UCG的 3d内作仰卧常规 1 2导联ECG检查。排除了心肌梗死、预激综合征、室性心律、束支传导…     

胸前导联最大QRS波振幅诊断左室肥厚的研究

目的通过验证如下两项基本假设提出心电图(ECC)诊断左室肥厚(LVH)的新指标:①胸导联最大QRS振幅(Vmax)应该比某一特定导联的R或S波能更好地反映左室心肌重量(LVM);②体重/身高比值(WT/HT)可近似地代替左室中心到胸壁距离的平方而用以校正胸导联QRS振幅。方法将76例高血压患者常规12导联心电图与M型超声心动图左室心肌重量(LVM)及左室心肌重量指数(LVMI)进行分析比较。结果Vmax是与心室重量指数(LVMI)相关最密切的心电图指标(r=0.545,p<0.001)。Vmax乘以WT/HT后,与心室重量指数(LVMI)的相关系数由r=0.442提高到r=0.659(p<0.05)。结论①胸导联最大QRS振幅可能取代常规的电压指标,作为心电图左室肥厚的诊断新指标;②Vmax乘以WT/HT可进一步提高其诊断效能。     

实时三维超声心动图评价高血压患者左心室心肌质量及左心房功能

目的应用实时三维超声心动图技术评价高血压患者左心室质量、左心房功能,并对左心室质量的测量与常规M型方法进行对照。方法在37名健康人、39例高血压无左心室肥厚(NLVH)患者和27例高血压伴左心室肥厚(LVH)患者中进行了超声心动图检查。应用M型超声心动图测量左心室质量(LVM)并计算左心室质量指数(LVMI),实时三维超声测量左心室质量(LVM)及LVMI,左心房舒张末容积(LAEDV)、左心房收缩末容积(LAESV),左心房射血分数(LAEF),并比较高血压组(NLVH组、LVH组)与健康对照组之间的差异。结果对照组、高血压NLVH组、LVH组3组间左心室质量指数两种检测方法差异均具有统计学意义(P<0.05),并且发现三维超声检测结果较M型测量数值低。左心房收缩功能指标各组间差异均有统计学意义(P<0.05)。在左心室重构、心肌质量增大的高血压患者,左心房容积增大,而收缩功能减低。结论实时三维超声技术能够定量评价高血压患者左心房功能,测量左心室质量。     

高血压左室肥厚超声心动图与心电图的对比分析

心脏是高血压直接受累的主要器官,其表现是左心室肥厚(LVH)。目前认为高血压LVH本身就是独立的危险因素。早期及时准确诊断LVH对于判断预后,制定治疗方案、预防心血管并发症具有重大意义。LVH最可靠的诊断方法是心血管造影,但属有创性,不易重复,应用受到限制。超声心动图(UCG)、心电图(ECG)是无创性诊断LVH方法。ECG又是诊断LVH最经典的,其准确性报道不一,而以UCG的敏感性和准确性最高。本文应用UCG测量左心室重量指数(LVMI),对ECG诊断LVH标准的准确性进行再评价,     

高血压左心室肥厚患者B型钠尿肽与早期舒张功能不全的关系

目的研究B型钠尿肽(BNP)与高血压左心室肥厚(LVH)以及LVH时无症状的左心室舒张性心功能不全(LVDD)的关系,探讨高血压LVH伴LVDD时的诊断方法。方法 113例高血压患者采用彩色多普勒超声心动图检测舒张末左心室室间隔厚度(IVSD)、左心室后壁厚度(PWT)、二尖瓣舒张早期最大峰值速度(E)、舒张晚期最大峰值速度(A)、E/A、左心室等容舒张时间(IVRT)等,计算左心室重量(LVM)、左心室重量指数(LVMI);采用酶联免疫法检测BNP,BNP与高血压LVH及LVDD的关系采用相关性分析。结果所有患者BNP与收缩压呈正相关(r=0.190,P<0.05),与IVSD、PWT、LVM、LVMI呈正相关(r=0.399、0.394、0.678、0.795、P<0.01);与E、E/A呈负相关(r=-0.885、-0.869,P<0.01);与A、IVRT呈正相关(r=0.735、0.817,P<0.01)。BNP在82.79ng/L时,诊断LVDD的敏感性为90%,特异性为100%,准确性为92%。结论高血压LVH时,BNP明显升高,而当高血压LVH伴LVDD时,BNP升高更明显,BNP是反映LVH及LVH伴早期LVDD的敏感指标。     

Cornell指数和Sokolow指数诊断左室肥大的价值

比较和评估Cornell指数与传统Sokolow指数诊断左室肥大(LVH)的价值,探索进一步提高心电图诊断性能的可能性。以1999～2003年我院体检及住院患者为研究对象,共499例。依据超声心动图测定的左室重量指数(LVMI)分为正常组(男210例、女83例)和LVH组(男126例、女80例)。计算Cornell指数和Sokolow指数的诊断灵敏度、特异度和准确率,以及不同特异度条件下的电压阈值及其相应的灵敏度和准确率。结果:两指数诊断男、女LVH的特异度大体相当,均>95%;男、女性Cornell指数的灵敏度和准确率高于Sokolow指数。把Cornell指数的特异度降为95%时,其诊断准确率可由80%提高到82%;调整电压阈值,Sokolow指数的最高诊断准确率为84%,但其特异度仅为85%。结论:Cornell指数诊断LVH的性能优于Sokolow指数;适当调整电压阈值标准可进一步改善两指数的心电图诊断性能,但改善的空间有限。     

SaVR与RaVL+SV3在诊断左心室肥大中的价值

目的探讨心电图（ECG）aVR导联的S波电压在诊断左心室肥大（LVH）中的价值。方法以超声心动图（UCG）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RaVL＋Sv3电压和SaVR电压,计算RaVL＋Sv3电压、SaVR电压及两者联用标准在诊断LVH中的敏感性、特异性及准确性。结果①SvVR电压诊断LVH的敏感性低（35％）,特异性高（100％）,准确性为67．5％;②RaVL＋Sv3电压诊断LVH的敏感性（60％）较SaVR电压的敏感性高,但特异性下降（84％）,准确性为72％;③两者联用可提高诊断LVH的敏感性及准确性,特异性却无明显降低,分别为：69％、76．5％、84％;与QRS波电轴的关系：伴QRS波电轴左偏者,诊断LVH的敏感性显著提高,为77．9％,准确性与特异性相近,分别为：78．8％、82.3％;④两者联用的标准在成人各年龄组及不同体型者诊断LVH的价值差异无显著意义（x^2=3．021,x^2=1．916,P〉0．05）。结论SaVR标准诊断LVH具有临床实用价值,与RaVL＋SV3标准联用更理想,可弥补单用的不足。     

高龄高血压患者动态脉压和血脂与左心室肥厚的关系

目的探讨高龄高血压患者动态脉压(APP)和血脂与左心室肥厚(LVH)的相关性。方法入选年龄≥80岁的高血压患者110例,进行24 h动态血压监测、超声心动图检查及血脂检测。根据APP分为高脉压组(≥60mm Hg,1 mm Hg=0.133 kPa)74例和低脉压组(<60 mm Hg)36例,以左心室重量指数(LVMI)作为LVH的诊断标准,又分为LVH组50例和非LVH组60例。并进行相关分析和logistic回归分析。结果与低脉压组比较,高脉压组LVMI、LVH的发生率及各收缩压参数明显升高(P<0.05)。LVH组24 h收缩压、昼间收缩压、APP、脉压指数明显高于非LVH组(P<0.05),2组舒张压差异无统计学意义(P>0.05)。LVMI与APP、脉压指数、24 h收缩压、昼间收缩压、夜间收缩压呈正相关,与HDL-C呈负相关(P<0.05),与所有舒张压参数均无相关性(P>0.05)。APP是LVH的独立危险因素(OR=1.057,95%CI:1.018～1.096,P=0.003)。结论在高龄高血压患者中,APP与LVMI密切相关,是LVH的独立危险因素;HDL-C与LVMI密切相关。     

Classification Accuracy of Electrocardiographic Criteria for Left Ventricular Hypertrophy in Normal Weight and Overweight Older Adults

Background: We evaluated classification accuracy of ECG criteria at varying levels of left ventricular hypertrophy (LVH) severity according to echocardiographically measured left ventricular mass (LVM) adjusted to body size. Methods: The test population was derived from the Cardiovascular Health Study (CHS), a population-based sample of 5201 men and women aged 65 and older, and consisted of 1844 women and 1119 men with adequate quality ECGs and echocardiograms for LVM determination. The criteria evaluated were Sokolow-Lyon, Cornell voltage, Cornell product, Framingham modification of the Cornell voltage, and the left ventricular mass index (LVMI) of the Novacode ECG program. Results: With LVH thresholds at upper 95% normal limit for weight adjusted LVM for the CHS population and ECG thresholds adjusted for 95% specificity in normal weight and overweight subgroups, the sensitivity of ECG criteria for LVH was relatively low. It was highest (40.8%) for the Novacode LVMI in normal weight men and for the Framingham criteria (30.9%) in normal weight women, but it deteriorated for both of these criteria in the presence of obesity. The overall performance of the Cornell product and Cornell voltage criteria was least influenced by obesity. The Framingham adjustment for the Cornell voltage criteria for obesity substantially reduced their sensitivity. Conclusion: The choice of echocardiographic standard, LVH severity level and overweight in the test groups have a strong influence on ECG evaluation results.     

Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings

In a previous study of 543 patients we developed, using echocardiographic left ventricular mass as the reference standard, two new sets of criteria that improve the electrocardiographic diagnosis of left ventricular hypertrophy (LVH). One set of criteria, which is suitable for routine clinical use, detects LVH when the sum of voltage in RaVL + SV3 (Cornell voltage) exceeds 2.8 mV in men and 2.0 mV in women. The second set of criteria, suitable for use in interpretation of the computerized electrocardiogram, uses logistic regression models based on electrocardiographic and demographic variables with independent predictive value for LVH, with separate equations for patients in sinus rhythm and atrial fibrillation. To test these criteria prospectively with use of a different reference standard, antemortem electrocardiograms were compared with left ventricular muscle mass measured at autopsy in 135 patients. Sensitivity of standard Sokolow-Lyon voltage (SLV) criteria (SV1 + RV5 or RV6 greater than 3.5 mV) for LVH was only 22%, but specificity was 100%. The Cornell voltage criteria improved sensitivity to 42%, while maintaining high specificity at 96%. Higher sensitivity (62%) was achieved by use of the new regression criteria, with a specificity of 92%. Overall test accuracy was 60% for SLV criteria, 68% for the Cornell voltage criteria, and 77% for the new regression criteria (p less than .005 vs SLV). We conclude that the Cornell voltage criteria improve the sensitivity of the electrocardiogram for detection of LVH and are easily applicable in clinical practice.(ABSTRACT TRUNCATED AT 250 WORDS)     

Does QRS Voltage Correction by Body Mass Index Improve the Accuracy of Electrocardiography in Detecting Left Ventricular Hypertrophy and Predicting Cardiovascular Events in a General Population?

The authors assessed the value of body mass index (BMI) correction of two electrocardiographic criteria in improving detection of left ventricular hypertrophy (LVH) and prediction of cardiovascular and all‐cause mortality in the Italian study Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) population. At entry, 1549 patients underwent diagnostic tests, 24‐hour ambulatory blood pressure (BP) monitoring, standard electrocardiography, and echocardiography. The BMI‐corrected Cornell voltage and Sokolow‐Lyon voltage criteria provided better results for detection of echocardiographic LVH as compared with unadjusted electrocardiographic parameters. Cornell voltage index, but not Sokolow‐Lyon index, was associated with an increased risk of cardiovascular events (and all‐cause mortality). The adjusted risk of cardiovascular events related to one‐standard deviation increment of BMI‐corrected Cornell voltage was similar to that conferred by the uncorrected criterion in the total population, but outperformed in obese participants. These findings show that correction for BMI may improve the diagnostic accuracy of Cornell voltage index in detecting LVH and prediction of cardiovascular mortality in obese individuals.     

Association between electrocardiographic left ventricular hypertrophy with strain pattern and left ventricular structure and function

BACKGROUND AND PURPOSE: Electrocardiographic left ventricular hypertrophy (LVH) with strain pattern has been documented as a marker for LVH. Its presence on the ECG of hypertensive patients is associated with poor prognosis. The study was carried out to assess the association of the electrocardiographic strain with left ventricular mass (LVM) and function in hypertensive Nigerians. MATERIAL AND METHODS: ECG as well as echocardiograms were performed in 64 hypertensive patients with ECG-LVH and strain pattern, 65 patients with ECG-LVH by Sokolow-Lyon (SL) voltage criteria and 62 normal controls. RESULTS: The study showed that electrocardiographic left ventricular (LV) strain pattern is associated with dilated left atrium, larger LV internal dimensions and greater absolute and indexed LVM in hypertensive Nigerians compared with ECG-LVH by SL voltage criteria alone or normal controls. CONCLUSION: The findings of this study support the fact that the ECG strain pattern is associated with increased LVM and an increased risk of developing abnormal LV geometry.     

左室质量比值和左室质量指数对高血压左室重构识别的比较

目的 比较左室质量比值(％PLM)和左室质量指数(LVMI)对左室重构识别的价值。方法 对187例高血压患者进行超声心动图检查，测量其心脏结构和功能。结果 左室质量适宜(aLVM)、过高(iLVM)和不足的分布分别占48.1％、48．7％和3．2％。％PLM与左室收缩功能的相关系数高于LVMI与左室收缩功能的相关系数。左室肥厚(LVH)时，iLVM的左室射血分数、左室短轴缩短率低于aLVM(P＜0．01)。但在aLVM或iLVM中．LVH和无LVH两组间的左室收缩功能无明显差异(P＞0．05)。结论 ％PLM识别左室重构比LVMI更符合生理情况，更能精确地对高血压患者进行危险分层。     

Validity of the ECG diagnosis of left ventricular hypertrophy in normotensive and moderately hypertensive men when using the echocardiographic assessment of left ventricular mass index as reference.

The diagnostic validity of ECG criteria for left ventricular hypertrophy (LVH) was assessed in 100 men aged 22-64 (mean 47) years with moderate hypertension (Group 1) and 95 age-matched normotensive men (Group 2) using echocardiographic recordings of LV mass index (MI) as reference. A diagnosis of LVH was made in subjects with LVMI greater than or equal to 125 g/m2. Mean LVMI was 126 +/- 34 g/m2 in Group 1 vs. 100 +/- g/m2 in Group 2 (P less than 0.001), and the prevalence of LVH was 48% and 11% respectively (P less than 0.001). The mean ECG voltage according to Sokolow-Lyon (S-L) was 28 +/- 8 mm in Group 1 and 27 +/- 7 mm in Group 2 (NS); with 19% having LVH in Group 1 and 14% in Group 2 (NS). Using the Cornell criterion Group 1 had on average 15 +/- 6 mm vs. 12 +/- 5 mm in Group 2 (P less than 0.001), but only two Group 1 patients had LVH. In Group 2 a significant negative correlation between age and S-L voltage was found (r = 0.33, P less than 0.001). LVMI was not correlated with any of the two voltage criteria using linear regression analysis whereas multiple regression analysis revealed a weak, but significant correlation between LVMI and S-L voltage in Group 1 (t = 2.06, P = 0.04). No subject had LV strain pattern or LVH according to the Romhilt Estes point score system. In the assessment of possible LVH in normal or moderately hypertensive men less than 65-70 years of age, ECG has limited value.     

Electrocardiographic criteria for the diagnosis of abnormal hypertensive cardiac phenotypes

This article compared the performance of 18 electrocardiographic (ECG) left ventricular hypertrophic (LVH) criteria and four P‐wave indices for the diagnosis of echocardiographic (ECHO) LVH and left atrial enlargement (LAE), including the deepest S‐wave amplitude added to the S‐wave amplitude of lead V₄ (S_D+SV₄) and P‐wave terminal force in lead V₁ (PTFV₁). A total of 152 middle‐aged hypertensive patients without evident cardiovascular diseases (CVDs) were enrolled. The gold standard for the diagnosis of LVH and LAE was ECHO left ventricular mass index (LVMI) and largest left atrial volume index (LAVI). For the detection of LVH, Sokolow‐Lyon voltage, Cornell voltage, Cornell product, S_D+SV₄, Manning, and R+S in any precordial lead had relatively higher sensitivity, especially S_D+SV₄ criteria. Their combination could further increase sensitivity (43% vs 29% [S_D+SV₄], P = 0.016). PTFV₁ was the only criterion that had significant diagnostic value for ECHO LAE (AUC, 0.68; 95% CI: 0.54‐0.73, P = 0.008). For middle‐aged hypertensive patients without evident cardiovascular diseases, S_D+SV₄ had the highest sensitivity for the diagnosis of LVH and the combination of several ECG LVH criteria might further increase sensitivity. PTFV₁ had significant diagnostic value for ECHO LAE.     

Relation of QT interval and QT dispersion to echocardiographic left ventricular hypertrophy and geometric pattern in hypertensive patients. The LIFE study. The Losartan Intervention For Endpoint Reduction

OBJECTIVE: In hypertensive patients, left ventricular hypertrophy (LVH) predicts increased mortality, in part due to an increased incidence of sudden death. Repolarization-related arrhythmogenesis may be an important mechanism of sudden death in hypertensive patients with LVH. Increased QT interval and QT dispersion are electrocardiographic (ECG) measures of ventricular repolarization, and also risk markers for ventricular tachyarrhythmias. We assessed the relation of QT intervals and QT dispersion to echocardiographically determined left ventricular (LV) mass and geometry in a large population of hypertensive patients with ECG evidence of LVH. METHODS: QT intervals and QT dispersion were determined from baseline 12-lead ECGs in 577 (57% male; mean age 65 +/- 7 years) participants in the LIFE study. LV mass index (LVMI) and geometric pattern were determined by echocardiography and QT interval duration and QT dispersion were assessed in relation to gender-specific LVMI quartiles. RESULTS: In both genders, increasing LVMI was associated with longer rate-adjusted QT intervals. QT dispersion measures showed a weaker association with LVMI quartiles. Both concentric and eccentric LVH were associated with increased QT interval duration and QT dispersion. These relations remained significant after controlling for relevant clinical variables. CONCLUSIONS: In hypertensive patients with ECG evidence of LVH, increased LVMI and LVH are associated with a prolonged QT interval and increased QT dispersion. These findings suggest that an increased vulnerability to repolarization-related ventricular arrhythmias might in part explain the increased risk of sudden death in hypertensive patients with increased LV mass.     

Ethnic differences in the identification of left ventricular hypertrophy in the hypertensive patient.

Left ventricular hypertrophy (LVH) is more prevalent in black than white hypertensives, but this difference is greater when identified by electrocardiography (ECG) than by echocardiography. We evaluated the proposal that current ECG criteria for LVH are less specific, and therefore, less useful, in blacks than whites. In a retrospective cross-sectional study, 408 subjects (271 white, 137 black) referred to a hypertension clinic for assessment of hypertension underwent measurement of blood pressure, ECG voltages (Sokolow-Lyon and Cornell sex-specific), and echocardiographic left ventricular mass index (LVMI). Black subjects had greater ECG voltages than whites, even when closely matched for LVMI. In black subjects, current ECG criteria were twice as sensitive as in whites (Sokolow-Lyon: 44.9% v 22.5%, P = .003. Cornell: 30.4% v 15.7%, P = .03). They were less specific in blacks using the Sokolow-Lyon criteria (73.5% v 86.8%, P = .02) but this failed to reach significance using the Cornell criteria (83.8% v 91.8%, P = .07). When voltage criteria were adjusted to give matched sensitivities and specificities, respectively, differences in specificity and sensitivity were no longer apparent. Receiver operating characteristic curve analyses confirmed no significant differences in overall performance of either ECG criteria between blacks and whites. In conclusion, ECG detection of LVH is insensitive in both ethnic groups. Sensitivity is higher in blacks due to higher LVMI in those with LVH. Apparent differences in specificity are due to ethnic differences in ECG voltages that are unrelated to differences in LVMI. When these differences are taken into account, there are no overall differences in test accuracy. However, given the prognostic importance of the detection of LVH, currently accepted ECG voltage criteria for the detection of LVH remain of equal or greater value in black hypertensives compared with whites.