ELECTROCARDIOGRAPHIC CHANGES IN PERICARDIAL-EFFUSION
ELECTROCARDIOGRAPHIC CHANGES IN PERICARDIAL-EFFUSION
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DOI：
10.1378/chest.104.5.1422
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发表时间：
1993-11-01
期刊：
影响因子：
9.6
通讯作者：
LEVENE, JF
中科院分区：
文献类型：
--
作者：
MEYERS, DG;BAGIN, RG;LEVENE, JF
目的：探讨心电图变化与心包积液之间的关联。背景：教科书中描述的与心包积液相关的心电图变化仅基于小系列的人类病例和动物数据。这些变化包括低 QRS 电压、电交替、P 波变化和 T 波倒置。 方法：所有接受过 2 次时间上独立的超声心动图和心电图检查的患者，其中 1 次超声心动图检查表明存在心包积液，另一次表明不存在心包积液（n = 46）。这些患者与 46 名无积液患者（对照受试者）进行年龄和性别匹配。超声心动图将心包积液分为少量（n = 28）、中度（n = 13）和大量（n = 5）。心电图变量由两名不了解积液状态的研究人员独立测量。结果：以重复测量的方式获得 46 名患者的 2 份时间上独立的心电图（一份在无积液时获得，另一份在存在积液时获得；中位时间间隔为 1.24 个月），只有窦性心律患者的平均心率（每分钟 98 次增加到每分钟 106 次）和 QRS 电压低于的患者百分比0.5 mV（10% 增加到 22%）与积液的发生有关。 QRS 波电压和积液量之间存在弱相关性 (r = 0.296)。仅五名大量积液患者中的一名发生了电交替，其他患者均未发生电交替。此外，当将 46 名患者的积液心电图与年龄和性别匹配的对照受试者的心电图进行比较时，心率差异（分别为每分钟 106 次和每分钟 80 次）和 QRS 电压的微小变化与积液状态相关。没有心电图变量对心包积液的检测敏感。结论：在重复测量和病例对照比较中，心电图结果太少、微妙、不敏感和非特异性，无法用作心包积液存在的指标。
Objective: To investigate the association between ECG changes and the presence of pericardial effusion.Background: The ECG changes associated with pericardial effusion described in textbooks are based only on small series of human cases and data from animals. These changes include low QRS voltage, electrical alternans, P wave changes, and T wave inversion.Methods: All patients who had undergone 2 temporally separate echocardiographic and ECG examinations, with 1 echocardiographic examination indicating the presence and the other indicating the absence of pericardial effusion were identified (n = 46). These patients were age- and sex-matched to 46 patients without effusion (control subjects). Pericardial effusion was classified echocardiographically as small (n = 28), moderate (n = 13), and large (n = 5). The ECG variables were independently measured by two investigators blinded to effusion status.Results: When 2 temporally separate ECGs for 46 patients were obtained in a repeated-measures fashion (1 obtained during the absence and the other during the presence of effusion; median time interval, 1.24 months), only the mean heart rate in patients with sinus rhythm (98 beats per minute increasing to 106 beats per minute) and the percentage of patients with QRS voltage of less than 0.5 mV (10 percent increasing to 22 percent) were associated with the development of effusion. A weak correlation (r = 0.296) was noted between QRS voltage and effusion size. Electrical alternans occurred only in one of the five patients with a large effusion but in no others. In addition, when the ECGs indicating effusion from the 46 patients were compared with the ECGs from their age- and sex-matched control subjects, differences in heart rate (106 beats per minute vs 80 beats per minute, respectively) and small changes in QRS voltage were associated with effusion status. No ECG variable was sensitive for the detection of pericardial effusion.Conclusions: In both repeated-measures and case-control comparisons, ECG findings are too few, subtle, insensitive, and nonspecific to be useful as indicators of the presence of pericardial effusion.