摘要
目的 探索高血压患者中不同心电图指标对超声左心室肥厚(LVH)和左心房增大的诊断价值及其与左心室舒张功能的关联性。方法入选2017年9-12月,北京市石景山区金顶街社区的高血压患者152(男44、女108)例,年龄30~65岁。采集并计算不同心电图指标,左心房异常指标包括肢体Ⅱ导联P波时长、胸前V1导联P波终末电势(PTFV1),LVH指标包括Sokolow-Lyon电压、Cornell电压、Cornell乘积和12导联中最大的S波振幅加上V4导联的S波振幅(SD+SV4)。采集所有受试者的超声心动图图像,以超声心动图测定的左心室质量指数(LVMI)和左心房最大容积指数(LAVImax)作为诊断LVH和左心房增大的金标准。结果 SD+SV4界值与超声LVMI界值诊断LVH的差异无统计学意义(P=0.557),其他心电图指标与LVMI比较,差异有统计学意义(P<0.05)。P波时长诊断左心房大小的价值无统计学意义[受试者工作特征曲线下面积(AUC)=0.51,P=0.795],而PTFV1对左心房大小的诊断价值有统计学意义(AUC=0.68,P=0.008)。经过校正后,多因素分析结果显示,PTFV1与左心室舒张功能指标,即二尖瓣舒张早期峰值血流流速和二尖瓣瓣环舒张早期运动速度的比值(E/e')相关(P=0.026)。结论使用SD+SV4界值对LVH的诊断灵敏度可能优于本研究中其他常见心电图指标,但尚需在不同人群的大样本研究中进一步验证。PTFV1诊断左心房大小的价值优于P波时长,且与左心室舒张功能相关。
Objective To explore the diagnostic values of different electrocardiographic criteria for echocardiographic left ventricular hypertrophy（LVH）and left atrial enlargement,and to analyze their association with left ventricular diastolic function. Methods Between September 2017 and December 2017,a total of 152 hypertensive patients aged 30-65 were enrolled from Jindingjie community,Shijingshan District,Beijing. Different electrocardiographic criteria were collected such as the left atrial abnormality criteria including P wave duration in Ⅱ,P wave terminal force in V1（PTFV1）,left ventricular hypertrophy（LVH）criteria including Sokolow-Lyon voltage,Cornell voltage,Cornell product and the deepest S wave amplitude with the S wave amplitude of lead V4（SD ＋SV4）added.All patients’ echocardiographic images were collected,the gold standard to diagnose LVH and left atrial enlargement were left ventricular mass index（LVMI）and largest left atrial volume index（LAVImax）. Results The difference between SD＋SV4 criterion and LVMI for the diagnosis of LVH was not significant（P=0.557）,in contrary to comparisons of other electrocardiographic criteria with LVMI. The diagnostic value of P wave duration was not significant[area under the receiver operating curve（AUC）=0.51,P=0.795],in contrary to PTFV1（AUC=0.68,P=0.008）. After adjustment,the only electrocardiographic criterion that was significantly associated with left ventricular diastolic function criterion,namely average mitral-to-peak early diastolic annular ratio（E/e’）was PTFV1（P=0.026）. Conclusion SD＋SV4 improves electrocardiographic sensitivity for the diagnosis of LVH. In the future,large studies enrolled various populations are needed to validate this information. The diagnostic value of PTFV1 is better than P wave duration;moreover,PTFV1 is significantly associated with left ventricular diastolic function.
作者
蒋雪丽
王晋泉
李艳丽
陈肯
马佳
李清霖
林莹
古丽拜合热姆.阿卜力米提
权欣
周宪梁
胡爱华
张宇清
JIANG Xue-li;WANG Jin-quan;LI Yan-li;CHEN Ken;MA Jia;LI Qing-lin;LIN Ying;GULIBAIHEREMU · A-bu-li-mi-ti;QUAN Xin;ZHOU Xian-liang;HU Ai-hua;ZHANG Yu-qing(Cardiovascular Department, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China)
出处
《中华高血压杂志》
CAS
CSCD
北大核心
2018年第6期541-545,共5页
Chinese Journal of Hypertension
基金
国家重点研发计划重大慢性病防控研究专项"肥胖和高血压的生活方式和营养干预技术及策略应用"项目(2016YFC1300100)
关键词
心电图
超声心动图
高血压
左心室肥厚
左心房增大
electrocardiography
echocardiography
hypertension
left ventricular hypertrophy
left atrial enlargement
