PERFORMANCE OF PRIMARY AND DERIVED M-MODE ECHOCARDIOGRAPHIC MEASUREMENTS FOR DETECTION OF LEFT-VENTRICULAR HYPERTROPHY IN NECROPSIED SUBJECTS AND IN PATIENTS WITH SYSTEMIC HYPERTENSION, MITRAL REGURGITATION AND DILATED CARDIOMYOPATHY
PERFORMANCE OF PRIMARY AND DERIVED M-MODE ECHOCARDIOGRAPHIC MEASUREMENTS FOR DETECTION OF LEFT-VENTRICULAR HYPERTROPHY IN NECROPSIED SUBJECTS AND IN PATIENTS WITH SYSTEMIC HYPERTENSION, MITRAL REGURGITATION AND DILATED CARDIOMYOPATHY
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DOI：
10.1016/0002-9149(86)90224-9
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发表时间：
1986-06-01
影响因子：
2.8
通讯作者：
ALONSO, DR
中科院分区：
文献类型：
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作者：
DEVEREUX, RB;CASALE, PN;ALONSO, DR
为了确定哪种M型超声心动图（回波）测量最能检测左心室（LV）肥大，在60例解剖肥大尸检患者和28例正常左心室尸检患者中测试了回波LV解剖测量正常上限的灵敏度和特异性（先前显示在正常受试者中具有97%的特异性）。在165名患有系统性高血压、二尖瓣返流或扩张型心肌病的存活患者中，通过每种超声标准确定肥厚的患病率。使用性别特异性超声心动图LV质量指数标准获得了尸检LV质量正常与增加患者之间的最佳分离（总体准确度= 88例患者中的73例，83%）。观察到超声心动图横截面积（88例患者中的59例，67%; p < 0.05 vs LV质量指数）和LV壁厚度指数（39 - 51%，p < 0.001）区分有和无肥厚患者的总体准确性较低。在113例中度或重度高血压、二尖瓣返流或扩张型心肌病的存活患者中，73%的患者左室质量指数增加，58%的患者左室横截面积指数增加（与左室质量指数相比p < 0.02），仅11%至32%的患者后壁厚度、间隔厚度和相对壁厚度增加（与左室质量指数相比p均< 0.001）。因此，（1）与尸检和临床参考标准相比，男性M型超声心动图LV质量指数大于134 g/m2和女性大于110 g/m2可准确检测到向心性和离心性LV肥大;（2）横截面积的有用性略低;（3）LV肥大的其他M型超声心动图标准表现太差，无法临床应用。
To determine which M-mode echocardiographic (echo) measurement best detects left ventricular (LV) hypertrophy, the sensitivity and specificity of upper normal limits of echo LV anatomic measurements (previously shown to have 97% specificity in living normal subjects) were tested in 60 necropsied patients with anatomic hypertrophy and in 28 necropsied patients with normal left ventricles. The prevalence of hypertrophy by each echo criterion was determined in 165 living patients with systemic hypertension, mitral regurgitation or dilated cardiomyopathy. The best separation between patients with normal vs increased necropsy LV mass was obtained using sex-specific echo LV mass index criteria (overall accuracy = 73 of 88 patients, 83%). Lower overall accuracies for separation of patients with and without hypertrophy were observed for echo cross-sectional area (59 of 88 patients, 67%; p < 0.05 vs LV mass index) and indexes of LV wall thickness (39 to 51%, p < 0.001). Among 113 living patients with moderate or severe hypertension, mitral regurgitation or dilated cardiomyopathy, LV mass index was increased in 73%, cross-sectional area index in 58% (p < 0.02 vs LV mass index), and posterior wall thickness, septal thickness and relative wall thickness in only 11 to 32% (all p < 0.001 vs LV mass index). Thus, (1) an M-mode echo LV mass index of more than 134 g/m2 in men and more than 110 g/m2 in women detects concentric and eccentric LV hypertrophy accurately by comparison with necropsy and clinical reference standards; (2) cross-sectional area is slightly less useful; and (3) other M-mode echo criteria of LV hypertrophy perform too poorly to be clinically applicable.