A novel electrocardiographic index for the diagnosis of diastolic dysfunction.
A novel electrocardiographic index for the diagnosis of diastolic dysfunction.
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DOI：
10.1371/journal.pone.0079152
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Brugada P
中科院分区：
文献类型：
--
作者：
Namdar M;Biaggi P;Stähli B;Bütler B;Casado-Arroyo R;Ricciardi D;Rodríguez-Mañero M;Steffel J;Hürlimann D;Schmied C;de Asmundis C;Chierchia GB;Sarkozy A;Lüscher TF;Jenni R;Duru F;Paulus WJ;Brugada P
虽然舒张功能障碍（DD）的评估是常规心脏检查的一个组成部分，但对相关的心电图（ECG）变化知之甚少。我们的目的是研究心电图指标对DD患者识别的潜在作用。与DD的超声心动图结果相关的ECG参数进行了回顾性评估，在172人的衍生组（83名对照与正常舒张功能，89例DD患者）和他们的诊断性能进行了测试，在50名对照组和50例患者的验证组。DD 1级和2级患者组显示QTc较长（422± 24 ms和434± 32 ms vs. 409± 25 ms，p<0.0005）和更短的Tend-P和Tend-Q间期，反映了电和机械故障（240± 78 ms和276± 108 ms对比373± 110 ms，p<0.0001; 409± 85 ms和447± 115 ms对比526± 119 ms，p<0.0001）。患者组的PQ间期显著延长（169± 28 ms和171± 38 ms vs. 153± 22 ms，p<0.005）。在调整可能的混杂因素后，（Tend-P/[PQxAge]）对DD的识别表现出高性能，在验证组中保持稳健（敏感性82%，特异性93%，阳性预测值93%，阴性预测值82%，准确性88%），并证明与左心房容积指数相结合时具有实质性的附加值（LAESVI，敏感性90%，特异性92%，阳性预测值95%，阴性预测值86%，准确性91%）。一种新的心电图指数Tend-P/（PQxAge）证明了DD诊断的高诊断准确性，并在与LAESVI结合时产生了实质性的附加值。
Although the assessment of diastolic dysfunction (DD) is an integral part of routine cardiologic examinations, little is known about associated electrocardiographic (ECG) changes. Our aim was to investigate a potential role of ECG indices for the recognition of patients with DD. ECG parameters correlating with echocardiographic findings of DD were retrospectively assessed in a derivation group of 172 individuals (83 controls with normal diastolic function, 89 patients with DD) and their diagnostic performance was tested in a validation group of 50 controls and 50 patients. The patient group with a DD Grade 1 and 2 showed longer QTc (422±24ms and 434±32ms vs. 409±25ms, p<0.0005) and shorter Tend–P and Tend–Q intervals, reflecting the electrical and mechanical diastole (240±78ms and 276±108ms vs. 373±110ms, p<0.0001; 409±85ms and 447±115ms vs. 526±119ms, p<0.0001). The PQ–interval was significantly longer in the patient group (169±28ms and 171±38ms vs. 153±22ms, p<0.005). After adjusting for possible confounders, a novel index (Tend–P/[PQxAge]) showed a high performance for the recognition of DD, stayed robust in the validation group (sensitivity 82%, specificity 93%, positive predictive value 93%, negative predictive value 82%, accuracy 88%) and proved a substantial added value when combined with the indexed left atrial volume (LAESVI, sensitivity 90%, specificity 92%, positive predictive value 95%, negative predictive value 86%, accuracy 91%). A novel electrocardiographic index Tend–P/(PQxAge) demonstrates a high diagnostic accuracy for the diagnosis of DD and yields a substantial added value when combined with the LAESVI.
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