心电图电压标准诊断左室肥大价值的研究

目的 评价临床上最常用的几项心电图电压标准诊断左室肥大（LVH）的价值及性别差异。方法 选择1999—2003年我院体检及住院患者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饲，女83例）和左室肥大组（男126例，女80例）。计算各项电压标准诊断左室肥大的敏感性、特异性和准确率，并比较各项电压标准诊断左室肥大的性别差异。结果 各项电压标准诊断左室肥大的特异性均〉95％,在单项指标中，Rvs〉2．5my标准的敏感性和准确率分别为62．8％和85．1％，明显高于Rvs及RaVL电压标准。在复合指标中，Comell指数和Sokolow指数诊断左室肥大的敏感性和准确率明显高于R4＋Sm指标。男、女性采用相同的电压阈值，其诊断性能存在明显性别差异。结论 Cornell指数、Sokolow指数及Rv5电压标准是诊断左宣肥大较好的指标。男、女性采用不同的电压阈值标准，可望进一步改善目前心电图诊断左室肥大的性能。     

SaVR电压标准与RV5(6)+SV1电压标准联用诊断左室肥厚的价值

目的:探讨心电图aVR导联的S波电压在诊断左室肥厚(LVH)中的价值.方法:以超声心动图结果为诊断标准,测量LVH者60例(A组)及无LVH者40例(B组)的心电图RV5(6) SV1电压和SaVR电压,计算RV5(6) SV1电压标准和SaVR电压标准及两者联用标准诊断LVH的敏感性、特异性及准确性,并进行显著性检验.结果:① SaVR电压标准诊断LVH的敏感性低(36.6%),特异性高(100%),准确性为62.0%;② RV5(6) SV1电压标准诊断LVH的敏感性(58 3%)较SaVR电压标准高,但特异性下降(85.0%),准确性为69.0%;③两者联用诊断LVH的敏感性及准确性提高,特异性无明显降低,分别为:73.3%、78.0%、85.0%.两者联用中,A组有44例、B组有6例符合LVH的心电图标准.结论:SaVR电压标准诊断LVH具有实用价值,与RV5(6) SV1电压标准联用更理想,可弥补单用的不足.     

ACE inhibitors and regression of left ventricular hypertrophy.

Left ventricular hypertrophy (LVH) is a common condition and a powerful independent risk factor for coronary heart disease, congestive heart failure, and other cardiac morbidity. It is associated with the male sex and advancing age. Its most common cause is hypertension, and many antihypertensive agents induce regression of LVH. Angiotensin-converting enzyme (ACE) inhibitors have been shown to reverse LVH by a mechanism as yet unknown. Reduction in afterload and other hemodynamic abnormalities by reduction of blood pressure is clearly a factor, but ACE inhibitors also block adrenergic action and other sympathetic nervous system influences, and the reduction in angiotensin II produces many effects. By inhibiting this potent vasoconstrictor and suppressing its degradation of the powerful vasodilator bradykinin, and by promoting sodium and water excretion, ACE inhibitors contribute to the restoration of normal ventricular function. Angiotensin II promotes protein synthesis in myocardial myocytes, and blocking this action may arrest the hypertrophic process. To determine the effect of angiotensin II on LVH and normalization of LV function, a study is now underway evaluating the effects of lisinopril, a new lysine analog of enalapril, and a diuretic agent in the treatment of hypertension LVH.     

伊贝沙坦对高血压左室肥厚患者的左室结构的影响

目的 研究伊贝沙坦对高血压左室肥厚（LVH）患者的左室结构的影响。方法 60例原发性高血压左室肥厚患者随机分为2组：治疗组每天口服伊贝沙坦150mg，对照组每天口服氨氯地平5mg。平均12个月，观察用药后血压、左室结构的变化。结果 用药后2组收缩压（SBP）和舒张压（DBP）均显著降低（P〈0．01）；室间隔厚度（IVST）及左室后壁厚度（LYPWT）均变薄（P〈0．01），左室重量指数（LYMI）明显减少（P〈0．01），对照组各项指标无明显变化（P〈0．05）。结论 对原发性高血压左室肥厚的患者，长期应用伊贝沙坦具有良好降压效果，同时还可逆转LVH，改善患者预后。     

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。     

Correlation of electrocardiographic left ventricular hypertrophy criteria with left ventricular mass by echocardiogram in obese hypertensive patients

Introduction

Left ventricular hypertrophy (LVH) and obesity are important cardiovascular risk factors. This study evaluates the influence of obesity on the diagnostic performance of the most used electrocardiographic criteria for LVH in hypertensive patients.

Methods

One thousand two hundred four outpatients from the Hypertensive Unit of the Hospital São Paulo, São Paulo, SP, Brazil, were studied. All underwent 12-lead electrocardiogram and echocardiogram. The most known electrocardiographic criteria for LVH were assessed and compared with the left ventricular mass index obtained by echocardiogram in obese and nonobese groups of hypertensive patients.

Results

The population's mean age was 57.4 ± 4.7 years; 351 were men (29.1%) and 853 women (70.8%). Cornell voltage, Cornell duration, Sokolow-Lyon voltage, Romhilt-Estes criteria, and R wave in aVL 11 mm or higher showed a positive correlation with left ventricular mass index (P < .05). Notwithstanding, there were no changes regarding specificity for obese or nonobese characteristics. However, sensitivity had a statistically significant decrease in obese patients in regard to Sokolow-Lyon voltage and Romhilt-Estes criteria and strain pattern (P < .05).

Conclusion

Cornell voltage and Cornell duration criteria, Perugia score, R wave in aVL, and QTc variable had no significant changes in diagnostic sensitivity in the obese patients.     

Electrocardiographic left ventricular hypertrophy has low diagnostic accuracy in middle-aged subjects

Objective. To evaluate the usefulness of electrocardiographic left ventricular hypertrophy (ECG LVH) as a marker of LVH in middle-aged subjects. Methods. LVH was determined by cardiovascular magnetic resonance imaging (MRI) in 188 apparently healthy middle-aged [97 men (45±7 years) and 91 women (47±6 years)]. Receiver operating characteristic (ROC) curves, test sensitivity, specificity, positive and negative predictive values for identifying LVH at different ECG criteria were calculated. Results. Systolic and diastolic blood pressures were 142±13 mmHg and 90±8 mmHg in men and 139±10 mmHg and 90±8 mmHg in women, respectively. LVMI was 78±17 g/m² in men and 67±12 g/m² in women, and 14% of men and 22% of women had LVH in cardiac MRI. Only Sokolow-Lyon and Sokolow-Lyon product had the area under the ROC curve over 0.70. Sokolow-Lyon product had the highest sensitivity (47%). All ECG criteria had high negative predictive values, but the positive predictive values were below 46%. Conclusions. Commonly used ECG criteria of LVH have low discrimination ability in middle-aged subjects. ECG LVH alone should not be used as a marker of target organ damage in middle-aged, never treated and apparently healthy hypertensives.     

高血压与左心室肥厚

左心室肥厚 ( LVH)是心血管疾病的重要危险因素 ,高血压是 LVH最常见的原因。本文就高血压患者 LVH的诊断方法、致病因素、病理生理、不良后果及药物治疗等问题作介绍     

Association between fasting plasma glucose and left ventricular mass and left ventricular hypertrophy over 4 years in a healthy population aged 60 and older

OBJECTIVES: To test the association between fasting glucose level and left ventricular mass (LVM) and left ventricular hypertrophy (LVH) in people aged 60 and older. DESIGN: Population-based prospective study with 4-year follow-up. SETTING: Department of Internal Medicine and Family Medicine, Kaohsiung Medical University (KMU), Chung-Ho Memorial Hospital, and Graduate Institute of Medicine and Public Health, KMU. PARTICIPANTS: Of 1,500 people screened, 105 without symptoms or signs of diabetes mellitus, hypertension, or cardiovascular disease were recruited from senior activity centers in Kaohsiung city. MEASUREMENTS: All received two-dimensional echocardiography and fasting glucose examination at baseline and at 2- and 4-year follow-up. LVH was defined as a LVM index (LVMI) greater than 122.4 g/m(2) or 51 g/m(2.7). RESULTS: Age ranged from 60 to 81 (mean 71.7+/-3.9). Baseline glucose ranged from 83 to 118 mg/dL (mean 99.7+/-7.9 mg/dL). LVMI was significantly higher at the 4-year follow-up (97.5+/-24.9 vs 104.5+/-27.5 g/m(2) and 44.2+/-12.1 vs 47.2+/-13.4 g/m(2.7), both P<.01), as was the occurrence of LVH (16% vs 32% and 25% vs 39%, both P<.01). Baseline glucose correlates with 4-year change in LVMI (both P<.02). In the fourth year, baseline glucose was a significant predictor of LVMI (both P<.01) and LVH (P=.03 in g/m(2) definition) using logistic regression analysis. CONCLUSION: Because fasting glucose is an independent predictor for greater LVM and for development of LVH, it should be considered in assessment of cardiac disease and LVM in healthy older people without diabetes mellitus.     

Comparison of electrocardiographic versus echocardiographic detection of left ventricular mass changes over time and evaluation of new onset left ventricular hypertrophy

We assessed the value of 3 electrocardiographic (EKG) voltage criteria in detecting variations of left ventricular mass (LVM) over time, taking echocardiographic (ECHO) LVM as reference, in the Pressioni Arteriose Monitorate E Loro Associazioni study. In 927 subjects (age 47 ± 13 years on entry, 49.9% men) an ECHO evaluation of LVM and EKG suitable for measurement of EKG-LVH criteria (Sokolow-Lyon voltage, Cornell voltage and R-wave voltage in aVL) were available at baseline and at a 2^nd evaluation performed 10 years later. Δ (delta) LVM, Δ LVMI, and Δ EKG parameters values were calculated from 2^nd evaluation to baseline. The sensitivity of the EKG criteria in the diagnosis of LVH, poor at baseline, becomes even worse after 10 years, reaching very low values. Only the sensitivity of R-wave amplitude exhibited slight increase over time but with unsatisfactory absolute values. Despite the prevalence of ECHO-LVH at the 2^nd evaluation was threefold increased compared to baseline (29.3% and 33.7% for LVM indexed to BSA and height^2.7, respectively), the prevalence of EKG-LVH was unchanged when evaluated by Sokolow-Lyon criteria, significantly reduced when assessed by Cornell voltage index, while significantly increased using R-wave voltage in aVL criteria. Despite an ECHO-LVM increase over the time, mean EKG changes were of opposite sign, except for R-wave amplitude in aVL. Our study highlights the discrepancy between ECHO and EKG in monitoring LVM changes over the time, especially for Sokolow-Lyon and Cornell voltage. Thus, EKG is an unsuitable method for the longitudinal evaluation of LVM variations.     

小儿12导联QRS总振幅正常值及对先心病左室肥大的诊断价值

观察１４０例健康儿童（２８天－１４岁）及１２０例先心病患儿的心电图１２导联ＱＲＳ总振幅（ΣＱＲＳ）。健康儿童ΣＱＲＳ的９５％正常值范围为１４０－２５０ｎｍ。以ΣＱＲＳ〉２５０ｍｍ为诊断儿童左室肥大标准，对先心病并左室肥大诊断的敏感性为８３．３３％，特异性为９７．８６％，准确性为９１．１５％，与其他心电图指标比较，特异性相近，而敏感性及准确性明显提高，认为ΣＱＲＳ是一项诊断儿童先心病并左室肥大的新指     

Regression of left ventricular mass in systemic hypertension.

The importance of treatment in systemic hypertension and cardiovascular morbidity and mortality has been established. Although systemic hypertension is the most important factor in the pathogenesis of left ventricular hypertrophy, other factors such as catecholamines and renin-angiotensin system may be involved. Increased left ventricular mass causes reduction in coronary reserve and may lead to acute ischemic events. Equally efficacious antihypertensive agents may have diverse effects on left ventricular hypertrophy and left ventricular function. New tomographic techniques with improved spatial resolution are emerging in the evaluation of left ventricular mass and may therefore provide better assessment of changes in left ventricular mass. With improved measures of left ventricular mass the question as to whether regression of left ventricular mass provides an additional benefit beyond control of blood pressure in hypertensive individuals may be finally answered.     

Discrepancy between increased left ventricular mass and "normal" QRS voltage is associated with decreased connexin 43 expression in early stage of left ventricular hypertrophy in spontaneously hypertensive rats

Background and Purpose

On the basis of our previous results of animal and human studies, we assume that the discrepancies between increased left ventricular mass (LVM) and electrocardiographic (ECG) findings not exceeding the upper normal limits in left ventricular hypertrophy (LVH) are conditioned by the electrical remodeling of hypertrophied myocardium. We assumed that these discrepancies observed in the early stage of LVH in spontaneously hypertensive rats (SHR) are associated with a decreased expression of connexin 43.

Methods

Standard 12-lead ECG was recorded in 20-week-old male SHR and age-matched and sex-matched normotensive Wistar rats (Institute of Experimental Pharmacology SAV, Dobra Voda, Slovakia). The approximated maximum QRS spatial vector magnitude (QRSmax) was calculated from leads V₂, aVF, and V₅. Left ventricular mass was weighed, and the specific potential (SP) of myocardium was calculated as the QRSmax-to-LVM ratio. Left ventricular protein levels of connexin 43 were analyzed with sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blotting.

Results

The LVM values were significantly higher in SHR than in normotensive controls (0.96 ± 0.03 g and 0.680 ± 0.07 g, respectively; P < .001). The QRSmax values in SHR did not follow the increase either in systolic blood pressure or in LVM. The SP values in SHR were significantly lower than those in control rats (0.92 ± 0.11 mV/g and 1.358 ± 0.06 mV/g, respectively; P < .01). A 37% decrease in connexin 43 level was observed in SHR.

Conclusions

The QRS voltage did not follow the increase in the LVM in 20-week-old SHR, and the values of connexin 43 were lower in SHR than in normotensive controls. We believe that the discrepant findings between ECG voltage and LVM can be caused by the electrical remodeling in the early stages of LVH.     

Aging and left ventricular mass and function in people with end-stage renal disease

OBJECTIVES: To identify the main age‐related factors responsible for cardiomyopathy in people with end‐stage renal disease (ESRD). DESIGN: Cross‐sectional. SETTING: Dialysis unit. PARTICIPANTS: Two hundred fifty‐four individuals undergoing chronic dialysis. MEASUREMENTS: Left ventricular (LV) systolic function (assessed according to midwall fractional shortening (mwFS)) and LV mass index (LVMI). RESULTS: At echocardiography, 196 (77%) participants displayed LV hypertrophy (LVH) and 123 (48%) had LV systolic dysfunction. On univariate analysis, age was related directly to LVMI (correlation coefficient (r)=0.33, P<.001) and inversely to mwFS (r=?0.23, P<.001) and a 10‐year increase in age was associated with 4.2‐g/m^2.7 greater LVMI and 0.5% lower mwFS. Albumin, pulse pressure, cardiovascular comorbidities, and C‐reactive protein were age‐related risk factors for LVMI and mwFS, whereas hemoglobin was an age‐dependent risk factor only for LVMI and heart rate and diabetes mellitus only for mwFS. After adjusting for age‐related risk factors, the predictive value of age for cardiomyopathy was substantially less (–67%) and the age‐dependent variability in LVMI and mwFS was much attenuated (?61%), and neither was significant. CONCLUSION: This study suggests that in people with ESRD, the relationship between age and cardiomyopathy is largely dependent on age‐related risk factors and that interventions focused on modifiable risk factors linked to age (e.g., malnutrition and inflammation) could attenuate the detrimental effect of aging on cardiovascular risk in the dialysis population.     

高血压病左室肥大Q-T离散度异常与室性心律失常的关系

观察180例高血压病患者的Q-T离散度(Q-Td),左室肥大组及左室正常组Q-Td分别为67.31±13.57和38.8±8.55ms(P<0.001),左室肥大组室性心律失常检出率为92.5%,其中复杂性者为64.2%,室速为23.9%,该组中Q-Td>60ms 3项检出率均高于<60ms及左室正常组中Q-Td>60ms者,复杂性室性心律失常及室速有显著性差异(P<0.001).提示高血压左室肥大Q-Td增加与室性心律失常尤其是复杂性室性心律失常及室速有一定关系,结合左室重量指数(LVMI)和Q-Td可作为评估高血压病患者预后的参考指标.     

Influence of hypertension, left ventricular hypertrophy, and left ventricular systolic dysfunction on plasma N terminal proBNP

OBJECTIVES: To examine the relation between plasma concentration of the N terminal of the precursor of brain natriuretic peptide (NT proBNP), left ventricular hypertrophy (LVH), and left ventricular systolic dysfunction (LVSD) in patients with a history of hypertension. DESIGN: Prospective study. SETTING: Teaching hospital based study. PATIENTS: NT proBNP concentrations were determined in five groups of individuals. Group 1: 15 echocardiographic normal controls; group 2: 22 patients with hypertension, normal left ventricular systolic function, and no LVH; group 3: 24 patients with hypertension, normal left ventricular systolic function, and LVH; group 4: 13 patients with history of hypertension, no history of ischaemic heart disease, and left ventricular wall motion index (WMI) between 1.9-1.3; and group 5:17 patients with a history of hypertension, no history of ischaemic heart disease, and WMI < 1.2. RESULTS: Median (range) NT proBNP concentrations (in fmol/ml) for groups 1-5, respectively, were: 129.4 (53.6-159.7), 147.4 (54.3-730. 5), 137.1 (35.8-403.9), 356.7 (124.4-934.4), and 493.5 (248.9-909). Mean log NT proBNP differed among all five groups (p < 0.0001), and between groups 4 and 5 versus groups 1-3 (p < 0.0001), and group 4 versus group 5 (p = 0.02) only. CONCLUSIONS: The results suggest that the presence of hypertension with or without LVH (and normal left ventricular systolic function) does not affect NT proBNP concentrations. Moreover, there is a significant rise in NT proBNP only when LVSD develops in hypertension. Thus, NT proBNP remains a useful diagnostic aid for LVSD, even in hypertensive patients.     

Survival and trends of occurrence of left ventricular hypertrophy,gender differences, 1967-92: The Reykjavik Study

OBJECTIVE: We estimated the prevalence, incidence and risk factors of left ventricular hypertrophy (LVH) in a prospective cohort study of 26 489 participants. MATERIAL AND METHODS: The LVH was defined as Minnesota Code 310 on electrocardiogram (ECG). Everyone with this code at first visit was defined as a prevalence case and those who developed it between subsequent visits were incidence cases. The comparison cohort were all other participants in the Reykjavik Study stages I-V. RESULTS: A total of 297 men and 49 women were found to have LVH of 3.2% and 0.5%, respectively. The incidence was 25 per 1000 per year amongst men and six per 1000 per year amongst women. Prevalence in both genders increased with increasing age. Risk factors at the time of diagnosis were systolic blood pressure [odds ratio (OR) per mmHg 1.02; 95% confidence interval (CI): 1.01-1.03], age (OR per year 1.04; 95% CI: 1.02-1.05), silent myocardial infarction (MI) (OR 3.18; 95% CI: 1.39-7.27) and ST-T changes (OR 3.06; 95% CI: 2.14-4.38) amongst men and systolic blood pressure and age for women with similar odds ratio. Predictive factors for acquiring LVH were systolic blood pressure [incidence ratio (IR) 1.01; 95% CI: 1.01-1.02] and angina with ECG changes (IR 2.33; 95% CI: 1.08-5.02) amongst men and systolic blood pressure amongst women (IR 1.03; 95% CI: 1.01-1.04). The risk for coronary mortality was significantly increased amongst women with hypertrophy [hazard ratio (HR) 3.07; 95% CI: 1.5-6.31] and their total survival was poorer with increasing time from diagnosis of LVH (HR 2.17; 95% CI: 1.36-3.48). CONCLUSIONS: We conclude that the presence of LVH and its appearance is associated with age and increased blood pressure amongst both genders. Women with LVH have poorer survival than other women and they are at threefold risk of dying of ischaemic heart disease.