Eelectrocardiographic correlates of ultrasonically increased septal, left ventricular posterior wall and left ventricular internal dimensions.

The electrocardiograms (ECG) of 64 subjects who exhibited an echocardiographically demonstrable increase in thickness of the interventricular septum and left ventricular posterior wall (Group 1, 22 patients), isolated left ventricular internal dimension (Group 2,26 patients), combined wall thickness and chamber diameter (Group 3, 2 patients), and septal thickness, (Group 4, asymmetric septal hypertrophy, 14 patients) were reviewed in order to determine sensitivity of ECG criteria for the diagnosis of left ventricular hypertrophy (LVH) proposed in 1949 by Sokolow and Lyon (13), in 1968 by Romhilt and Estes (14), and in 1973 the New York Heart Association (15). Relative sensitivity of the three methods was as follows: Total group, NYHA (77%) greater than Sokolow and Lyon (67%) greater than Romhilt and Estes (58%); Group 1, NYHA (91%) greater than Sokolow and Lyon (73%) greater than Romhilt and Estes (54%); Group 2, NYHA and Sokolow and Lyon (65%) greater than Romhilt and Estes (61%); Group 4, NYHA (79%) greater than Sokolow and Lyon (64%) greater than Romhilt and Estes (57%). We conclude that 1)ECG criteria of the NYHA for the diagnosis of LVH correlate best with an increase of ultrasonically determined septal, left ventricular posterior wall or left ventricular internal dimensions when compared with voltage criteria of Sokolow and Lyon and the point score system of Romhilt and Estes; and 2) isolated increase of left ventricular internal dimension, in the absence of thickened septum or posterior left ventricular wall, frequently results in ECG criteria compatible with the diagnosis of LVH.     

Electrocardiographic Criteria of Left Ventricular Hypertrophy in Patients with Morbid Obesity

Background: Obesity is frequently accompanied by systemic hypertension complicated by left ventricular hypertrophy (LVH). Standard electrocardiography (ECG) is generally accepted screening tool for LVH in systemic hypertension. The aim was to assess currently used ECG criteria in the diagnosis of LVH in morbidly obese patients. Methods: Ninety‐five patients (80 women, 15 men) with body mass index ≥ 40 kg/m², prior to scheduled bariatric surgery were included into the study. All patients underwent standard ECG and transthoracic ECG for LVH assessment. Results: Echocardiographically LVH (>110 g/m² in women, and >132 g/m² in men) was diagnosed in 54 patients (56.8%). None of the ECG criteria showed satisfactory performance in the diagnosing echocardiographically confirmed LVH. Although, Receiving operating curves (ROC) analysis showed that only Romilht‐Estes score and Cornell index × QRS complex duration were characterized by area under curve >0.6 (0.662; 0.612, respectively),currently recommended values of both tests (Romilht‐Estes score and Cornell index × QRS duration 2436 mm · ms) showed very low sensitivity in morbidly obese patients (0% and 2%, respectively). Conclusions: Our study showed that none of voltage‐based ECG criteria are of value for LVH diagnosis in severely obese patients. Only Romhilt‐Estes scale and Cornell indices could be helpful for the identification of LVH in the group of patients with morbid obesity, but their value is far from being satisfactory. Ann Noninvasive Electrocardiol 2011;16(3):258–262     

Evaluation of the electrocardiogram RV5/V6 criteria in the diagnosis of left ventricular hypertrophy in marathon runners

To assess the value of electrocardiogram (ECG) RV5/V6 criteria for diagnosing left ventricular hypertrophy (LVH) in marathons. A total of 112 marathon runners who met the requirements for “Class A1” events certified by the Chinese Athletics Association in Changzhou City were selected, and their general clinical information was collected. ECG examinations were performed using a Fukuda FX7402 Cardimax Comprehensive Electrocardiograph Automatic Analyser, whereas routine cardiac ultrasound examinations were performed using a Philips EPIQ 7C echocardiography system. Real-time 3-dimensional echocardiography (RT-3DE) was performed to acquire 3-dimensional images of the left ventricle and to calculate the left ventricular mass index (LVMI). According to the LVMI criteria of the American Society of Echocardiography for the diagnosis of LVH, the participants were divided into an LVMI normal group (n = 96) and an LVH group (n = 16). The correlation between the ECG RV5/V6 criteria and LVH in marathon runners was analysed using multiple linear regression stratified by sex and compared with the Cornell (SV3 + RaVL), modified Cornell (SD + RaVL), Sokolow–Lyon (SV1 + RV5/V6), Peguero–Lo Presti (SD + SV4), SV1, SV3, SV4, and SD criteria. In marathon runners, the ECG parameters SV3 + RaVL, SD + RaVL, SV1 + RV5/V6, SD + SV4, SV3, SD, and RV5/V6 were able to identify LVH (all p < .05). When stratified by sex, linear regression analysis revealed that a significantly higher number of ECG RV5/V6 criteria were evident in the LVH group than in the LVMI normal group (p < .05), both with no adjustment and after initial adjustment (including age and body mass index), as well as after full adjustment (including age, body mass index, interventricular septal thickness, left ventricular end-diastolic diameter, left ventricular posterior wall thickness, and history of hypertension). Additionally, curve fitting showed that the ECG RV5/V6 values increased with increasing LVMI in marathon runners, exhibiting a nearly linear positive correlation. In conclusions, the ECG RV5/V6 criteria were correlated with LVH in marathon runners.     

Prognostic value of left ventricular hypertrophy in hypertensive patients: A meta‐analysis of electrocardiographic studies

Electrocardiographic left ventricular hypertrophy (LVH) has been used to predict adverse outcomes in different clinical settings. This meta‐analysis aimed to compare the prognostic value of different electrocardiographic criteria of LVH at baseline in hypertensive patients. A systematic literature search was conducted in PubMed and Embase databases until December 3, 2019. Cohort studies that reported the association of baseline electrocardiographic LVH (Sokolow‐Lyon voltage, Cornell voltage or Cornell product) with all‐cause mortality or major cardiovascular events in hypertensive patients were included. The prognostic value of LVH was expressed by the risk ratio (RR) with 95% confidence interval (CI). Nine studies involving 41 870 hypertensive patients were identified. Comparison with those with and without LVH patients indicated that the pooled RR value of all‐cause mortality was 1.30 (95% CI 1.01‐1.66) for the Sokolow‐Lyon voltage criteria, 1.33 (95% CI 1.20‐1.47) for the Cornell voltage criteria, and 1.31 (95% CI 0.97‐1.78) for the Cornell product criteria. In addition, the pooled RR of major cardiovascular events was 1.53 (95% CI 1.27‐1.86) for the Sokolow‐Lyon criteria and 1.46 (95% CI 1.22‐1.76) for the Cornell voltage criteria, respectively. This meta‐analysis suggests that different electrocardiographic criteria for detecting LVH at baseline differ in prediction of all‐cause mortality in patients with hypertension. LVH detected by the Cornell voltage and Sokolow‐Lyon criteria can independently predict the major cardiovascular events in hypertensive patients.     

A meta‐analytic evaluation of the diagnostic accuracy of the electrocardiographic Peguero‐Lo Presti criterion for left ventricular hypertrophy

Although electrocardiography (ECG) is a cost‐effective and convenient tool for routine screening of left ventricular hypertrophy (LVH), its performance has been shown to be poor. The Peguero‐Lo Presti, a novel voltage criterion, was found to be potentially better than the most commonly used criteria. We conducted a systematic review and meta‐analysis of its diagnostic accuracy compared to Cornell and Sokolow‐Lyon voltage criteria. Bibliographic databases were searched to identify relevant articles. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (ROC) curves were performed for comparison. Ten studies reporting data from 5984 individuals were included in the meta‐analysis. Peguero‐Lo Presti had the highest pooled sensitivity (43.0%, 95% confidence interval [CI]: 30.2‐56.9) followed by Cornell (26.1%; 95% CI: 16.9‐37.9) and Sokolow Lyon (22.0%; 95% CI: 14.1‐32.7). However, Peguero‐Lo Presti had the lesser pooled specificity (90.5%; 95% CI: 86.3‐93.5) and Cornell the highest (94.9%; 95% CI: 90.3‐97.3). The pooled DOR was 6.63 (95% CI: 3.95‐11.13), 5.50 (95% CI: 3.64‐8.30), and 2.94 (95% CI: 2.20‐3.92) for Peguero‐Lo Presti, Cornell, and Sokolow‐Lyon, respectively. Peguero‐Lo Presti had the best accuracy according to summary ROC curves, with an area under the curve of 0.827 compared to 0.715 for Cornell, and 0.623 for Sokolow‐Lyon. In conclusion, according to this meta‐analysis, Peguero‐Lo Presti has a better diagnostic performance than Cornell and Sokolow‐Lyon and might be more useful in routine clinical practice as a screening tool for LVH.     

ECG low QRS voltage and wide QRS complex predictive of centenarian 360-day mortality

We examined the electrocardiographic (ECG) findings of centenarians and associated them with >360-day survival. Physical and functional assessment, resting electrocardiogram and laboratory tests were performed on 86 study participants 101.9?±?1.2 years old (mean?±?SD) (70 women, 16 men) and followed for at least 360 days. Centenarian ECGs were assessed for left ventricular hypertrophy (LVH) according to the Romhilt–Estes score, Sokolow–Lyon criteria and Cornell voltage criteria which were positive for 12.8, 6.98, and 10.5 % of participants, respectively. Fifty-two study participants (60 %) survived ≥360 days. Multivariate logistic regression analysis revealed a negative relationship between 360-day survival and the following: R II <0.45 mV adjusted for CRP (odds ratio (OR)?=?0.108, 95 % confidence interval (CI)?=?0.034–0.341, P?<?.001), R aVF?<?0.35 mV adjusted for CRP (OR?=?0.151, 95 % CI?=?0.039–0.584, P?<?.006), Sokolow–Lyon voltage <1.45 mV adjusted for CRP (OR?=?0.178, 95 % CI?=?0.064–0.492, P?=?.001), QRS ≥90 ms adjusted for CRP (OR?=?0.375, 95 % CI?=?0.144–0.975, P?=?.044), and Romhilt–Estes score ≥5 points adjusted for sex and Barthel Index (OR?=?0.459, 95 % CI?=?0.212–0.993, P?=?.048) in single variable ECG models. QRS voltage correlated positively with systolic and pulse pressure, serum vitamin B12 level, sodium, calcium, phosphorous, TIMP-1, and eGFR. QRS voltage correlated negatively with BMI, WHR, serum leptin, IL-6, TNF-α, and PAI-1 levels. QRS complex duration correlated positively with CRP; QTc correlated positively with TNF-α. Results suggest that Romhilt–Estes LVH criteria scores ≥5 points, low ECG QRS voltages (Sokolow–Lyon voltage <1.45 mV), and QRS complexes ≥90 ms are predictive of centenarian 360-day mortality.     

Comparison of usefulness of Sokolow and Cornell criteria for left ventricular hypertrophy in subjects aged <20 years versus >30 years

The use of electrocardiography in sports or military screening is considered an effective tool for diagnosing potentially fatal conditions. The present study was designed to compare the yield of electrocardiographic criteria for left ventricular hypertrophy (LVH) criteria for the diagnosis of LVH and hypertrophic obstructive cardiomyopathy in subjects aged <20 years and >30 years. The association between the electrocardiographic (ECG) criteria for LVH (ECG-LVH) and echocardiographic findings was compared in 4 groups of air force academy candidates: (1) young candidates undergoing echocardiography because of ECG-LVH findings (n = 666); (2) young candidates without ECG-LVH findings undergoing routine echocardiography (n = 4,043); (3) older designated aviators undergoing echocardiography because of ECG-LVH findings (n = 196); and (4) older designated aviators undergoing routine echocardiography without ECG-LVH findings (n = 1,098). The predictive value of ECG-LVH findings for echocardiographic LVH, left ventricular mass, posterior wall thickness, and interventricular septal thickness were compared among the 4 groups. The ECG criteria in young subjects correlated with the left ventricular mass and posterior wall thickness but not with the interventricular septal thickness. In older subjects, these criteria correlated with left ventricular mass, interventricular septal, and posterior wall thickness. The positive and negative predictive value of ECG-LVH findings for the echocardiographic diagnosis of LVH in young subjects was 6.0% and 99.0%, respectively. In older subjects the positive and negative predictive value of ECG-LVH findings was 34% and 93%, respectively. In conclusion, ECG criteria are probably a useful tool for exclusion of LVH in young and older subjects; however, their low positive predictive value would probably lead to unnecessary echocardiographic tests, particularly in young subjects.     

The strain pattern,and not Sokolow–Lyon electrocardiographic voltage criteria,is independently associated with anatomic left ventricular hypertrophy

Although obesity and chest-wall thickness influence the Sokolow–Lyon electrocardiographic (ECG) voltage criteria and strain pattern, these factors have not been taken into account in previous studies that evaluate the relationship between the ECG criteria and anatomic left ventricular hypertrophy (LVH). The introduction of multislice computed tomography (MSCT) has enabled assessment of not only coronary artery stenoses but also left ventricular volume and mass, left atrial volume, and chest-wall thickness. We hypothesized that evaluating the relation between the ECG voltage criteria or strain pattern and the aforementioned factors using MSCT would be highly valuable. The study population consisted of 93 patients who required MSCT angiography. The Sokolow–Lyon voltage and strain patterns were determined to detect anatomic LVH, which was defined as increased left ventricular mass. The Sokolow–Lyon voltage criteria, as an indicator of anatomic LVH, had a sensitivity of 57 %, specificity of 67 %, positive predictive value of 36 %, and negative predictive value of 82 %. By contrast, the strain pattern had a sensitivity of 65 %, specificity of 87 %, positive predictive value of 63 %, and negative predictive value of 88 %. Multivariate analysis revealed that the strain pattern was associated with the presence of anatomic LVH, whereas the Sokolow–Lyon voltage was not. This MSCT study demonstrated that even after removing the effects of various factors, the strain pattern remained associated with the presence of anatomic LVH, in contrast to the Sokolow–Lyon voltage.     

Electrocardiography and left ventricular voltage in Saudi Arabian military recruits

Normal limits for selected electrocardiographic measurementswere determined in 120 healthy male Saudi Arabian military recruits.These were compared with widely accepted normal values previouslyestablished in 115 healthy American men of similar age by Simonson.While most measurements were closely similar, left ventricularchest lead voltages were significantly higher in the recruits.Similar findings have previously been described in Africans,but not in an Arabic population. The application of left ventricularhypertrophy (LVH) voltage criteria recommended by the WorldHealth Organisation for epidemiological studies was found toproduce an unacceptable number of false positives in our subjects.Conversely, the ‘point score’ LVH criteria of Romhiltproduced only one false positive. We recommend first: carefulevaluation of left ventricular voltage in the ECGs of SaudiArabian (and, by implication, other Middle Eastern) patientsseen in Europe and secondly; that the Romhilt point score systemshould replace the currently recommended LVH voltage criteriafor epidemiological studies in developing countries.     

维持性血液透析患者颈动脉硬化与左心室肥厚的相关分析

目的：研究维持性血液透析（MHD）患者颈动脉硬化程度与左心室肥厚的关系。方法：收集48例MHD患者性别，年龄，体重，身高，BMI及病程等一般临床资料；静脉血查血红蛋白（Hb），尿素氮，肌酐，白蛋白，前白蛋白，总胆固醇，三酰甘油（TG），高密度脂蛋白胆固醇（HDL-C），低密度脂蛋白胆固醇（LDL-C），C反应蛋白（CRP），彩色B型超声仪观测双侧颈总动脉、颈动脉分叉处及颈内动脉的解剖及血流动力学，包括斑块，血管内皮厚度（即内膜-中膜厚度，IMT）等，并用超声心动图测定患者心脏的左心室内径、左心房内径、左心室后壁厚度（LVPWT）、室间隔厚度、左心室射血分数等。结果：48例患者中有28例（58％）颈动脉斑块阳性，颈动脉斑块阳性组患者年龄大于颈动脉斑块阴性组（P〈0．01），TC（P〈0．01）、LDL-C（P〈0．05）、CRP（P=0．01）、颈动脉内．中膜厚度（CCA-IMT）（P〈0．01）及左室心肌质量指数（LVMI）（P〈0．001）明显高于颈动脉斑块阴性组。性别分布、透析时间、收缩压、舒张压、脉压、TG、及Hb两组间无明显差异。48例患者中有37例（77％）有左室肥厚，左室肥厚组患者收缩压、舒张压及脉压明显高于无左室肥厚组（P〈0．01）；左室肥厚组高血压的发生率及LVMI明显高于无左室肥厚组（P〈0．001），CCA-IMT明显高于无左室肥厚组（P〈0．05），颈动脉斑块发生率明显高于无左室肥厚组（P〈0．01），而Hb则明显低于无左室肥厚组（P〈0．01）。两组之间在性别年龄分布、透析时间、CRP则无明显差别。相关性分析显示，LVMI与收缩压和脉压高度相关（P〈0．001），与舒张压和CCA-IMT中度相关（P〈0．01），与Hb呈负相关（P〈0．01）。结论：MHD患者颈动脉硬化与左室肥厚关系密切，动脉硬化的治疗有可能预防和逆转MHD患者的左室肥厚。     

高血压病左室结构功能变化与血浆内皮素的相关性

目的 :探讨高血压病患者左室结构 ,功能变化与血浆内皮素 （ET）的关系。方法 :原发性高血压不伴左室肥厚（L VH）组 （EH） 35例 ,伴 L VH组 （EH+ L VH） 2 8例 ,正常对照组 30例。放射免疫法测定血浆 ET水平 ,超声心动图检测心脏结构与功能。计算左室重量指数 （L VMI） ,平均室壁厚度 （MWT） ,相对室壁厚度 （RWT）。结果 :EH组及 EH+ L VH组血浆 ET高于正常对照组 （P<0 .0 1） ,EH + L VH组 ET高于 EH组 （P<0 .0 1） ,ET与 L VMI,MWT室间隔厚度 ,左室后壁厚度呈正相关 （r分别为 0 .42 4,0 .316 ,0 .2 6 8和 0 .317,均 P<0 .0 1） ,ET与 E/ A呈负相关 （r=-0 .30 4,P<0 .0 1）。结论 :ET与高血压和 L VH相关。     

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.     

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.     

The distribution of left ventricular hypertrophy in hypertrophic cardiomyopathy: comparison to athletes and hypertensives

Cross-sectional echocardiogaphy was performed in 134 patientswith hypertrophic cardiomyopathy and 75 with secondary leftventricular hypertrophy (57 hypertensives and 18 athletes) todetermine the diagnostic sensitivity and specificity and predictivevalue of the pattern of left ventricular hypertrophy. Myocardialwall thickness was assessed in the anterior and posterior septum,free wall and posterior wall in both the upper and lower leftventricle. All patients had at least one region exceeding 2SD from normal (>l-4cm). Asymmetrical septal hypertrophy)septum to posterior wall ratio 1.5: 1 in the upper or lowerleft ventricle) was found in 75 patients with hypertrophic cardiomyopathy(56%), 11 hypertensives (18%) and 4 (22%) athletes. This patternwas more common in patients with primary compared to secondaryleft ventricular hypertrophy (P<0.01). Distal ventricularhypertrophy was only seen in patients with hypertrophic cardiomyopathy(10%). Symmetrical left ventricular hypertrophy was demonstratedin 45 patients with hypertrophic cardiomyopathy (34%), 50 hypertensives(82%) and 14 athletes (78%). This pattern was significantlymore common in patients with secondary left ventricular hypertrophy(P<0.01). Amongst those with symmetrical hypertrophy, patientswith hypertrophic cardiomyopathy had more severe hypertrophywhile the athletes had larger left ventricular cavity size.Asymmetrical septal hypertrophy was the most sensitive (56%)and distal ventricular (100%) the most specific pattern forthe diagnosis of hypertrophic cardiomyopathy with a predictivevalue of 83 and 100% respectively. Symmetrical left ventricularhypertrophy was 81% sensitive and 66% specific with a predictivevalue of 58% for the diagnosis of secondary hypertrophy. Inconclusion, the pattern of hypertrophy was of only moderatepredictive value in differentiating primary from secondary leftventricular hypertrophy.     

Validity of electrocardiographic indices of left ventricular hypertrophy in athletes

The Authors have evaluated the reliability of the most important electrocardiographic criteria for left ventricular hypertrophy in a group of 95 athletes. An ECG and a M- and B-mode echocardiogram have been performed in each subject; the criteria by Sokolow and Lyon, by Cornell, by Gubner, by Romhilt and Estes and by Casale have been employed to evaluate left ventricular hypertrophy. Left ventricular mass has been evaluated by the echocardiogram according to Devereux and coll. The electrocardiographic method by Casale and coll., proposed only for a few years, is based on the valuation of R wave and on the study of ventricular repolarization depending on sex and age. By this method, still now not much used in the study of athletes, a good correlation with the echocardiographic data was expected, in relation to the young age of the population. The athletes have been divided into three groups, practising aerobic sports, aerobic-anaerobic sports and power sports, according to the physiologic classification of the sports activities of Dal Monte. Using the chi-squared test, for the whole population and separately for the three groups, no significant statistical correlation has been observed. In conclusion, the results demonstrate that not only the "classic" criteria, but also the most recent ECG criteria of left ventricular hypertrophy are not reliable in evaluating left ventricular hypertrophy in trained athletes, leaving the final assessment of the real state of the cardiac chambers to echocardiography.     

Echocardiographic diagnosis of left ventricular hypertrophy.

Echocardiograms were obtained on 27 adults with electrocardiographic criteria of left ventricular hypertrophy (LVH) to determine how echocardiograms might best identify LVH. Both the left ventricular (LV) posterior wall thickness and interventricular septal thickness were found by echocardiography to be increased (greater than or equal to 12 mm) in only 13 of 27 patients (48%) with LVH. The LV was dilated (greater than or equal to 58 mm) in the absence of posterior wall thickening in 9 of 27 patients (33%). The LV mass, estimated from standardly measured dimensions, was increased (greater than 200 g) in 21 of 27 patients (78%) and when measurements were made by the Penn method, mas was increased in all patients. These observations indicate that the echocardiographic estimation of LV mass is a more sensitive indicator of LVH than LV posterior wall and septal thickness. Since LVH is defined as an increased mass of LV muscle, these observations are consistent with this fundamental definition of left ventricular hypertrophy.     

The echocardiographic correlates of left ventricular hypertrophy diagnosed by electrocardiography.

Echocardiography was performed in 28 consecutive patients who manifested accepted criteria for left ventricular hypertrophy on their electrocardiograms. Four groups of patients were identified: Group 1, nineteen (68%) who had an increase in both interventricular septal and left ventricular posterior wall thickness; Group 2, three patients (11%) with isolated enlargement of the left ventricular internal dimension; Group 3, two subjects (7%) with increased septal thickness, left ventricular posterior wall thickness and left ventricular internal dimension and Group 4, four patients (14%) with normal echocardiographic measurements. It is concluded that increases in both septal and left ventricular wall thickness are the primary echocardiographic correlates of left ventricular hypertrophy as diagnosed on the electrocardiogram.     

难治性高血压左心室肥厚与交感神经兴奋性关系的临床研究

目的:探讨难治性高血压患者左心室肥厚(LVH)与交感神经兴奋性之间的关系。方法:选取2014年1月至2015年6月就诊的200例难治性高血压患者,超声心动图测量室间隔厚度、左心室后壁厚度、左心室心肌质量、左心室质量指数等LVH相关指标,根据心脏超声结果分为不伴LVH组(不伴有LVH的难治性高血压患者,n=90)和LVH组(伴有LVH的难治性高血压患者,n=110)。根据24 h动态心电图结果计算平均心率、心率变异性时域指标和心率变异三角指数等交感神经兴奋性相关指标,比较两组平均心率和心率变异性。结果:与不伴LVH组相比,LVH组超声心动图LVH相关指标和平均心率均明显升高(P均0.05),心率变异性时域指标和心率变异三角指数明显降低(P均0.05)。结论:难治性高血压患者中,伴有左心室肥厚者交感神经兴奋性增强。     

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。