ELECTROCARDIOGRAPHIC IDENTIFICATION OF INCREASED LEFT-VENTRICULAR MASS BY SIMPLE VOLTAGE-DURATION PRODUCTS
ELECTROCARDIOGRAPHIC IDENTIFICATION OF INCREASED LEFT-VENTRICULAR MASS BY SIMPLE VOLTAGE-DURATION PRODUCTS
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DOI：
10.1016/0735-1097(94)00371-v
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发表时间：
1995-02-01
影响因子：
24
通讯作者：
KLIGFIELD, P
中科院分区：
文献类型：
--
作者：
OKIN, PM;ROMAN, MJ;KLIGFIELD, P
目标。本研究旨在验证QRS电压和持续时间的乘积作为QRS复合体时间电压面积的近似值的假设，可以提高超声心动图确定的左心室肥厚的心电图检测，并进一步评估QRS持续时间对心电图肥厚检测的相对贡献。左心室肥厚的心电图识别一直受限于灵敏度较差的标准电压标准。然而，左心室质量的增加与QRS复合体的时间电压区增加的关系比与QRS电压或持续时间的变化的关系更准确。389例患者获得标准12导联心电图和超声心动图，其中左室肥厚116例。用Cornell电压乘以QRS持续时间（Cornell积）和12导联电压之和乘以QRS持续时间（12导联积）计算简单电压持续时间乘积。在包括Cornell电压、Sokolow-Lyon电压、年龄和性别在内的逐步logistic回归模型中，QRS持续时间仍然是左心室肥厚存在的高度显著预测因子（卡方26.9,p < 0.0001）。在96%的匹配特异性下，与单独的简单电压标准相比，每个电压持续产品显著提高了左心室肥厚检测的敏感性（Cornell产品37% vs Cornell电压28%，p < 0.02, 12导联产品50% vs 12导联电压43%，p < 0.005）。康奈尔产品和12导联产品的敏感性均显著高于单独QRS持续时间的27%敏感性（p < 0.01 vs. p < 0.001）， Romhilt-Estes点评分bbbb4的20%敏感性（p < 0.001）和最佳拟合logistic回归模型的33%敏感性（p < 0.05 vs. p < 0.001）。QRS持续时间是左心室肥厚存在的独立心电图预测指标，相对于其他使用QRS持续时间和电压线性组合的ECG标准，康奈尔电压或12导联电压与QRS持续时间的简单乘积显著提高了左心室肥厚的识别。
Objectives. This study was conducted to validate the hypothesis that the product of QRS voltage and duration, as an approximation of the time-voltage area of the QRS complex, can improve the electrocardiographic (ECG) detection of echocardiographically determined left ventricular hypertrophy and to further assess the relative contribution of QRS duration to the ECG detection of hypertrophy.Background. The ECG identification of left ventricular hypertrophy has been limited by the poor sensitivity of standard voltage criteria alone. However, increases in left ventricular mass can be more accurately related to increases in the time-voltage area of the QRS complex than to changes in QRS voltage or duration alone.Methods. Standard 12-lead ECGs and echocardiograms were obtained for 389 patients, including 116 patients with left ventricular hypertrophy. Simple voltage-duration products were calculated by multiplying Cornell voltage by QRS duration (Cornell product) and the 12-lead sum of voltage by QRS duration (12-lead product).Results. In a stepwise logistic regression model that also included Cornell voltage, Sokolow-Lyon voltage, age and gender, QRS duration remained a highly significant predictor of the presence of left ventricular hypertrophy (chi square 26.9, p < 0.0001). At a matched specificity of 96%, each voltage-duration product significantly improved sensitivity for the detection of left ventricular hypertrophy compared with simple voltage criteria alone (Cornell product 37% vs. Cornell voltage 28%, p < 0.02, and 12-lead product 50% vs. 12-lead voltage 43%, p < 0.005). Sensitivities of both the Cornell product and the 12-lead product were significantly greater than the 27% sensitivity of QRS duration alone (p < 0.01 vs. p < 0.001), the 20% sensitivity of a Romhilt-Estes point score >4 (p < 0.001) and the 33% sensitivity of the best-fit logistic regression model in this cohort (p < 0.05 vs. p < 0.001).Conclusions. QRS duration is an independent ECG predictor of the presence of left ventricular hypertrophy, and the simple product of either Cornell voltage or 12 lead voltage and QRS duration significantly improves identification of left ventricular hypertrophy relative to other ECG criteria that use QRS duration and voltages in linear combinations.