Ethnic differences in the identification of left ventricular hypertrophy in the hypertensive patient
Ethnic differences in the identification of left ventricular hypertrophy in the hypertensive patient
复制标题
DOI：
10.1016/s0895-7061(99)00027-8
复制
发表时间：
1999-05-01
影响因子：
3.2
通讯作者：
Poulter, NR
中科院分区：
文献类型：
--
作者：
Chapman, JN;Mayet, J;Poulter, NR
在黑人高血压患者中，左心室肥厚(LVH)比白人高血压患者更常见，但这种差异在心电图(ECG)诊断时比超声心动图更大。我们评估了一种建议，即目前的心电图左室肥厚标准没有白人那么具体，因此在黑人中没有白人那么有用。在一项回顾性横断面研究中，408名受试者(271名白人，137名黑人)在高血压诊所接受了血压、心电电压(Sokolow-Lyon和Cornell性别特异性)和超声心动图左心室重量指数(LVMI)的测量。黑人受试者的心电图电压高于白人受试者，即使在左心室重量指数接近匹配的情况下也是如此。在黑人受试者中，目前的心电图标准的敏感性是白人的两倍(Sokolow-Lyon：44.9%vs22.5%，P=.003，Cornell：30.4%vs15.7%，P=.03)。使用Sokolow-Lyon标准对黑人的特异性较低(73.5%vs86.8%，P=0.02)，但使用康奈尔标准(83.8%vs91.8%，P=0.07)未达到显著水平。当电压标准被调整以分别给出匹配的灵敏度和特异度时，特异度和灵敏度的差异不再明显。受试者工作特征曲线分析证实，黑人和白人在两种心电图标准的总体表现上没有显著差异。总而言之，在两个民族中，检测左室肥厚的心电图是不敏感的。黑人的敏感度更高，这是因为有左心室肥厚的人的左心室指数较高。特异性的明显差异是由于与LVMI的差异无关的心电电压的种族差异。当考虑到这些差异时，测试准确度没有总体差异。然而，考虑到检测LVH的预后重要性，目前公认的检测LVH的心电图电压标准在黑人高血压患者中的价值仍然与白人相同或更高。(C)1999年《美国高血压杂志》。
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. (C) 1999 American Journal of Hypertension, Ltd.