高血压患者心电图TV_5异常与左室肥厚关系的探讨

近年来,“高血压与心脏”的问题日益受到临床重视。高血压病人血流动力学改变的结果因心脏收缩期负荷过重引起心肌单位的增大及数量增多,最终导致左室肥厚(LVH)。超声心动图发现50％以上的轻中型高血压病人在心脏结构上存在LVH。新近研究认为,利用超声心动图(UCG)测定左室质量指数(LVMI)判断LVH的准确性,特异性可达98％。然而,在目前临床工作中,心电图(ECG)仍是诊断LVH最常用的方     

高血压患者心电图TV5异常与左室肥厚关系的探讨

近年来，“高血压与心脏”的问题日益受到临床重视。高血压病人血流动力学改变的结果因心脏收鳍期负荷过重引起心肌单位的增大及数量增多，最终导致左室肥厚(LVH)。超声心动图发现50％以上的轻中型高血压病人在心脏结构上存在LVH。新近研究认为，利用超声心动图(UCG)测定左室质量指数(LVMI)判断LVH的准确性．特异性可达98%。然而，在目前临床工作中．心电图(ECG)仍是诊断LVH最常用的方法。但是．按照贯用的标准．其敏感性和特异性均较差。     

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 5 45 ,P <0 0 0 1)。结论　Vmax有希望成为ECG诊断LVH的有效实用的新指标     

超声心动图联合心电图对急性心肌梗死及其并发症的诊断价值

目的探讨超声心动图联合心电图对急性心肌梗死及其并发症的诊断价值。方法回顾性分析92例心肌梗死患者的超声心动图、心电图及冠状动脉造影资料,进行对比分析。结果超声心动图对心肌梗死的正确诊断率显著高于心电图,但差异无统计学意义(χ2=2.28,P0.05),心电图联合超声心动图的诊断率显著高于心电图和超声心动图(χ2=15.23,P0.01;χ2=5.42,P0.05)。不同病变部位正确检出率由高到低依次为左前降支、左前降支+右冠状动脉、右冠状动脉、3支、左回旋支、左前降支+左回旋支和左回旋支+右冠状动脉,其中左前降支病变正确检出率最高为96.43%,左回旋支+右冠状动脉的正确检出率最低为40.00%,二者比较,差异具有统计学意义(χ2=7.94,P0.01)。结论超声心动图联合心电图可提高单一诊断方法对急性心肌梗死的诊断率,超声心动图对急性心肌梗死病变部位及并发症的诊断具有一定临床价值。     

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。     

Cornell电压与高血压左室肥厚

高血压左室肥厚 (LVH)是心脏在高血压状态下对慢性适应力 (或伴容量负荷增加 )的一种适应性反应 ,是维持心脏功能的一种代偿 ,也是一个重构过程。左室肥厚不仅是高血压的常见并发症 ,而且也是心血管事件发生的一项独立危险因素 ;Framingham研究表明 4 5岁以上男子心电图出现LVH以后 ,6年死亡率可高达 4 0 %,高血压LVH患者易发生冠心病、心律失常、心力衰竭等 ,猝死率较高[1] 。因此 ,高血压左室肥厚的早期检出和有效逆转有着十分重要的临床意义 ,本文就高血压LVH的心电图Cornell诊断标准作一分析。1　ECG诊断LVH的历史回顾190 1年 ,…     

高血压左室肥厚与Cornell电压标准

高血压左室肥厚（LVH）的诊断目前主要依靠心电图（ECG）和超声心动图（UCG）检查。利用超声心动图检测左室质量指数（LVMI），能准确地反映LVH时的心脏变化，成为临床评价LVH的可靠指标。心电图是心脏常用的检查方法之一，但传统的ECG．LVH诊断敏感性仅为UCG-LVH的1／7～1／10，难以满足临床所需。美国Comell医学中心推出的心电图Comell电压标准（RaVL＋Sv3），国外通过临床试验，已显示出其对LVH诊断的高效关系。     

高血压致左室肥厚患者QT离散度分析

QT离散度 (QTd)是指 1 2导联体表心电图不同导联间QT间期的差异 ,反映的是心室肌复极的不一致性和心电的不稳定性〔1〕。我科 2 0 0 0年 6月～ 2 0 0 2年 1 2月收住原发性高血压 (EH)并左室肥厚 (LVH)患者 80例 ,通过与无LVH者 (对照组 )比较QTd的变化 ,探讨EHLVH患者QTd增加对评价致心律失常危险性的价值。1　对象与方法LVH组 :经常规体表 1 2导联同步心电图和M型超声心动图诊断为EH并LVH患者 80例 ,男 47例 ,女 33例 ,年龄 45～ 70 ( 68.1± 1 0 .7)岁 ,所选病例符合高血压及LVH诊断标准 ;对照组为同期EH住院患者 ,经心电…     

高血压患者心电图SD波在诊断左心室肥厚中的价值

目的测试一种新的心电图诊断标准,提高诊断原发性高血压病合并左心室肥厚的准确性。方法以美国超声心动图学会对左心室质量测量作为标准,选取高血压病(HBP)合并左心室肥厚(LVH)患者129例,同期根据年龄、性别匹配高血压左心室正常组(109名)。同步记录12导联心电图,选取所有心电图导联中最深S波(S_D)为研究对象,与采用目前公认的LVH心电图标准Cornell和Sokolow-Lyon进行比较,计算心电图相关指标判断HBP合并LVH的ROC曲线及其曲线下面积(AUC),获得鉴别的最佳临界值。结果心电图S_D预测HBP合并LVH的敏感度、特异度及AUC分别为86. 05%、81. 65%、0. 892;心电图S_D+Sv4显示最高的敏感度为88. 37%。等效性检验显示单导联S_D的AUC较Cornell、Sokolow-Lyon及S_D+Sv4标准Z值均具有统计学差异(P0. 05)。心电图S_D诊断男性HBP合并LVH的AUC及敏感度、特异度分别为0. 901、90. 29%、75. 34%,等效性检验均优于Cornell、Sokolow-Lyon及S_D+Sv4标准(P 0. 05)。结论心电图S_D诊断HBP合并LVH,提高了其诊断的敏感性,优于Cornell和Sokolow-Lyon标准,值得临床推广。     

左心室心肌质量的测量（待续）

左心室肥厚(LVH)是心血管事件的独立预测因子[1-3].左心室质量(LVM)增加者发生心血管事件的风险随之逐步升高[2].也有证据表明:伴LVH的高血压患者,心脑血管意外的发生率随着LVM的下降而降低[4].LIEF研究[5]揭示了逆转的LVH使心脏性猝死的风险下降约30%,而这些益处与降压程度、治疗方式及是否有冠心病无关.由于LVM直接与预后相关,因此,准确地测定LVM非常重要.心电图与超声心动图较早用于诊断LVH,近年来心脏磁共振成像(CMRI)、电子计算机断层扫描(CT)等技术亦能精确地测定LVM,然而各种检测方法的敏感性、特异性及临床应用各不相同,本文综述及评价多种方法的优劣.     

Variable patterns of ST-T abnormalities in patients with left ventricular hypertrophy and normal coronary arteries.

BACKGROUND--Classically, the ST-T configuration in the electrocardiogram of patients with left ventricular hypertrophy is said to have a typical pattern of ST depression together with asymmetrical T wave inversion (the so-called left ventricular strain pattern). However, many patients with left ventricular hypertrophy may also have ischaemic heart disease. To revise the electrocardiographic criteria for left ventricular hypertrophy the ST-T configuration in patients with left ventricular hypertrophy documented by echocardiography and with normal coronary arteries was assessed. METHODS--24 patients were selected for this study. All had left ventricular hypertrophy documented by echocardiography, normal coronary arteries by cardiac catheterisation, and ST and/or T wave abnormalities in the lateral leads of their electrocardiogram. There were eight patients with aortic valve disease and 16 with hypertension who had coronary angiography as part of an investigation into the risk factors of sudden cardiac death caused by hypertensive left ventricular hypertrophy. No patient was receiving digitalis preparations or had electrolyte disturbances, and none had a previous myocardial infarction or ventricular conduction defect. RESULTS--Typical electrocardiographic evidence of left ventricular strain was found in approximately two thirds (63%) of patients and 95% of this subgroup had asymmetrical T wave inversion. Flat ST segment depression, with or without T wave inversion or isolated T wave inversion (symmetrical or asymmetrical) in the anterolateral leads, was seen in the remaining 37% of patients. CONCLUSIONS--These findings indicate that left ventricular hypertrophy without coronary artery disease can cause variable types of ST-T abnormalities in the anterolateral leads including the typical left ventricular strain pattern and non-specific ST-T changes. Non-specific abnormalities could not be distinguished from those of coronary artery disease and may adversely affect the accuracy of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy because they do not accord with the criteria for left ventricular strain.     

Left ventricular hypertrophy, arrhythmias and sudden death in systemic hypertension

Left ventricular (LV) hypertrophy is a significant independent risk factor for mortality from coronary heart disease, including sudden death. The proportion of sudden death to total death due to coronary heart disease remains high, at about 50% to 60%, despite the continuing downward trend in coronary heart disease mortality observed in the U.S. during the last decade. Prevalence of LV hypertrophy, determined by electrocardiogram in hypertensive patients (diastolic blood pressure greater than or equal to 90 mm Hg), including tall R wave and evidence of repolarization abnormality, is around 5%. The prevalence of LV hypertrophy by echocardiography is estimated at 44% to 48%. LV hypertrophy on electrocardiogram underestimates the magnitude of the problem of LV hypertrophy in hypertensive patients. Its overall sensitivity is less than 60%. The incidence of LV hypertrophy in hypertensive patients is lower when hypertension is treated successfully than when the patient is left either untreated or inadequately treated; successful treatment of hypertension causes regression of LV hypertrophy. However, hypertensive patients with LV hypertrophy have a poor prognosis despite treatment. The available evidence derived from the results of large clinical trials suggests that hypertensive patients should be treated before there is electrocardiographic evidence of LV hypertrophy.     

Pathophysiologic assessment of hypertensive heart disease with echocardiography

Assessment of the pathophysiologic changes associated with systemic hypertension has been limited by difficulty in justifying invasive studies of the left ventricle. Echocardiography, because it is notinvasive, offers an attractive method of assessing cardiac dimensions and function in hypertensive heart disease. Fourteen age-matched normotensive subjects and 31 patients with hypertension (but without clinical evidence of coronary artery disease) were studied before receiving any antihypertensive therapy. The patients with hypertension were classified into three groups on the basis of previously established electrocardiographic and chest X-ray criteria: group I, normal electrocardiogram and chest roentgenogram (13 patients); group II, left atrial abnormality by electrocardiogram and a normal chest roentgenogram (8 patients); and group III, left ventricular hypertrophy by electrocardiogram or chest roentgenogram, or both (10 patients). Mean arterial pressure increased significantly from group I to group II and from group II to group III (P is less than 0.01), and this increase was associated with a similar progressive increase in left ventricular mass assessed with echocardiogram (P is less than 0.01). A significant increase was also found in both posterior wall and septal thickness in groups II (P is less than 0.05) and III (P is less than 0.01). In association with this increased mass a significant decrease in ejection fraction and fractional fiber shortening was demonstrated in groups II (P is less than 0.05) and III (P is less than 0.01) although cardiac index was reduced only in group III (P is less than 0.05). Thus, increased ventricular mass can be identified with echocardiography at an early stage of hypertensive heart disease when only left atrial abnormality is identifiable with electrocardiographic criteria and decreased left ventricular performance occurs with increasing arterial pressure and left ventricular hypertrophy.     

Left atrial enlargement: an early sign of hypertensive heart disease

Left atrial abnormality on the electrocardiogram (ECG) has been considered an early sign of hypertensive heart disease. In order to determine if echocardiographic left atrial enlargement is an early sign of hypertensive heart disease, we evaluated 10 normal and 14 hypertensive patients undergoing routine diagnostic cardiac catheterization for echocardiographic left atrial enlargement. All patients had normal coronary arteriography, sinus rhythm, normal left ventricular volumes and function, no valvular disease, and no echocardiographic or ECG left ventricular hypertrophy. No patient met ECG criteria for left atrial abnormality. The mean left atrial dimension was 3.46 +/- 0.3 cm in normal individuals versus 4.04 +/- 0.3 cm in the hypertensive patients (p less than 0.01). The left atrial index was also higher in the hypertensive group, 2.18 +/- 0.45 versus 1.88 +/- 0.10 cm/m2 (p less than 0.05), and the left atrial-to-aortic root dimension ratio was significantly higher in the hypertensive group, 1.36 +/- 0.20 versus 1.17 +/- 0.07 (p less than 0.01). We conclude that echocardiographic left atrial enlargement may be an early sign of hypertensive heart disease in patients with no other discernible cause of left atrial enlargement.     

Simple criteria for differentiation of Fabry disease from amyloid heart disease and other causes of left ventricular hypertrophy

AIMS: Fabry disease may be difficult to differentiate from other causes of left ventricular hypertrophy such as other myocardial storage diseases (including amyloidosis), hypertrophic cardiomyopathy (HCM), or hypertensive heart disease (HHD). We sought to determine simple criteria to best differentiate the above mentioned cardiac diseases. METHODS AND RESULTS: All patients in a six-year time period with left ventricular hypertrophy due to Fabry disease (13 patients), biopsy proven cardiac amyloidosis (16 patients), non-obstructive HCM (17 patients), and 22 randomly selected patients with advanced HHD were compared. Retrospective analysis of clinical characteristics, findings of electrocardiogram (ECG) and echocardiography by blind review was performed. RESULTS: No single clinical characteristic or findings of ECG or echocardiography could reliably differentiate between the various diseases. Increased echogenicity/granular sparkling, valvular abnormalities, abnormal renal function, and diastolic function were not helpful discriminators. In a univariate analysis, four criteria (acroparesthesia, anhydrosis, absence of hypertension and presence of Sokolow criteria for left ventricular hypertrophy in the ECG) were significant for Fabry disease. By logistic regression analysis, the following most suitable discriminative parameters were identified: hypertension in HHD (specificity 82%), orthostasis and/or pericardial effusion for amyloidosis (specificity 93%), papillary muscle anomaly in non-obstructive HCM (specificity 92%), and Fabry disease if neither hypertension orthostatis, pericardial effusion nor a papillary muscle anomaly was present (specificity 87%). CONCLUSION: A combination of symptoms, echocardiographic findings and ECG in unexplained left ventricular hypertrophy may help to differentiate amyloidosis, non-obstructive HCM and hypertensive heart disease from Fabry disease. The results of this preliminary study will have to be confirmed in a prospective study.     

Significance of asymmetrically inverted T wave

Two consecutive series of patients with a T wave asymmetry ratio of 2.0 or greater have been studied. Patients with bundle-branch block or who were on digoxin or a similar drug were excluded. In 50 of the 69 patients, the heart was examined either by echocardiography or by direct inspection. Sixty-one of the 69 patients had diseases commonly associated with left (or right) ventricular hypertrophy and/or dilatation. The remaining eight patients had clinically pure ischaemic heart disease. Of the 50 hearts examined by echocardiography or direct inspection (including six with pure ischaemic heart disease), 49 were found to have abnormal thickness of the left (or right) ventricle, or increased end-diastolic left ventricular diameter, or a combination of hypertrophy and dilatation. In 12 of the 47 patients with left ventricular hypertrophy or dilatation, the electrocardiogram did not satisfy the Sokolow and Lyon voltage criterion of left ventricular hypertrophy.     

Significance of asymmetrically inverted T wave.

Two consecutive series of patients with a T wave asymmetry ratio of 2.0 or greater have been studied. Patients with bundle-branch block or who were on digoxin or a similar drug were excluded. In 50 of the 69 patients, the heart was examined either by echocardiography or by direct inspection. Sixty-one of the 69 patients had diseases commonly associated with left (or right) ventricular hypertrophy and/or dilatation. The remaining eight patients had clinically pure ischaemic heart disease. Of the 50 hearts examined by echocardiography or direct inspection (including six with pure ischaemic heart disease), 49 were found to have abnormal thickness of the left (or right) ventricle, or increased end-diastolic left ventricular diameter, or a combination of hypertrophy and dilatation. In 12 of the 47 patients with left ventricular hypertrophy or dilatation, the electrocardiogram did not satisfy the Sokolow and Lyon voltage criterion of left ventricular hypertrophy.     

高血压左心室肥厚与室性过早搏动关系研究

目的：分析高血压左心室肥厚与室性过早搏动的关系。方法：通过超声心动图、动态心电图对87例高血压病人检查，分析高血压病人左心室肥厚与室性过早搏动的关系。结果：高血压左心室肥厚者定性过早搏动的发生率，LownⅢ级以上室性过早搏动的发生率均显著高于无左心室肥厚者（P＜0.05和P＜0．01），室性早搏的严重程度与左室厚度存在线性相关关系（r＝0．781，P＜0．01）。结论：高血压病人室性过早搏动的发生不仅与左室肥厚有关，且其程度与左室厚度有关。     

Morphological quantification and differentiation of left ventricular hypertrophy in hypertrophic cardiomyopathy and hypertensive heart disease. A two dimensional echocardiographic study

Differentiation between hypertrophic cardiomyopathy and hypertensive heart disease is a diagnostic challenge. M-mode echocardiography only permits assessment of hypertrophy in limited areas of the left ventricular wall. 2-D echocardiography allows visualization of most of the myocardium. To assess the reliability of conventional M-mode echocardiographic and 2-D echocardiographic criteria in patients with hypertrophic cardiomyopathy (HCM) and hypertensive heart disease (HY), 30 patients with hypertrophic cardiomyopathy and 30 patients with hypertension and severe cardiac hypertrophy were examined using M-mode and 2-D echocardiography. Although the M-mode echocardiographic features showed statistically significant differences between the mean values in the two groups, the degree of overlap made the differentiation of the individual patients difficult. The diagnostic sensitivity and specificity of classic echocardiographic features were assessed: ventricular septal thickness greater than or equal to 1.5 cm, 90% and 43% (sensitivity and specificity, respectively); ventricular septal thickness to posterior wall ratio greater than or equal to 1.5, 83% and 56%; cross-sectional area at papillary level greater than 21 cm2m-2, 80% and 73%; septal segment of the myocardial ring at papillary level greater than 6.5 cm2m-2, 80% and 87%; and the combined criteria of cross-sectional area at papillary level greater than 21 cm2m-2 and septal segment greater than 6.5 cm2m-2, 77% and 93%. Quantitative 2-D echocardiography is useful to differentiate patients with hypertrophic cardiomyopathy from those with secondary myocardial hypertrophy due to hypertension. Hypertrophic cardiomyopathy is characterized by a spectrum of different morphological patterns of hypertrophy. Patients with the predominant region of hypertrophy in the anterolateral free wall or the apical region of the left ventricle were not detected with our quantitative method. Patients with this type of hypertrophy are relatively rare in the western population.     

心磁图对冠心病心肌缺血与高血压心室肥厚的诊断价值

目的 探讨心磁图（MCG）在诊断冠心病心肌缺血及高血压左心室肥厚中的作用.方法 ①冠状动脉造影（CAG）的104例患者,分为CAG阳性的冠心病组及CAG阴性的非冠心病对照组,对照观察MCG与核素心肌灌注显像（MPI）在诊断冠心病中的应用价值.②收集所有同时行超声心动图（UCG）、CAG及MCG检查患者共205例,以UCG检查为诊断标准将患者分为左心室肥厚组（93例,室壁厚度≥12 mm）和对照组（112例,CAG阴性,室壁厚度〈12 mm）.确定QRS波最大磁通量（R1）、QRS波最小磁通量（R2）、QRS波最大磁通量与QRS波最小磁通量的差值（R1-R2）在左心室肥厚的诊断标准,并观察MCG在诊断左心室肥厚中的作用.结果 ①以CAG作为诊断冠心病的金标准,MCG7项参数中任意2项以上阳性,诊断冠心病的敏感性为81.25%,特异性为59.72%,任意3项以上阳性,诊断冠心病的敏感性为65.63%,特异性为69.44%.MPI诊断冠心病的敏感性为75.00%,特异性为79.20%.②确定R1、R2及R1-R2诊断左室肥厚的标准为〉18.5pT,〈-10pT及〉28pT,三项参数诊断高血压左心室肥厚的敏感性分别为58.82%、55.88%、55.88%,特异性分别为68.75%、80.36%、71.43%.MCG 7项复极参数中任意3项以上阳性,诊断左心室肥厚的敏感性为64.71%,特异性为69.64%.结论 ①心磁图与核素心肌灌注显像相似,在冠心病心肌缺血的诊断中具有较好的临床应用价值,MCG绝对无创,更易于临床推广应用.②心磁图在高血压左心室肥厚的诊断中具有较好临床应用前景.