左心室肥厚中壁厚和质量增加的电决定因素。,Journal of Electrocardiology

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左心室肥厚中壁厚和质量增加的电决定因素。
Journal of Electrocardiology ( IF 1.3 ) Pub Date : 2019-11-13 , DOI: 10.1016/j.jelectrocard.2019.09.024
Maren Maanja ₁ , Todd T Schlegel ₂ , Rebecca Kozor ₃ , Magnus Lundin ₁ , Björn Wieslander ₁ , Timothy C Wong ₄ , Erik B Schelbert ₄ , Martin Ugander ₅

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引言左心室肥厚 (LVH)，定义为左心室质量 (LVM) 增加，可表现为壁厚增加、心室扩张或两者兼而有之。现有的来自心电图 (ECG) 的 LVH 标准敏感性较差。然而，尚不清楚心电图是否可以分别检测壁厚和质量的变化。方法包括接受心血管磁共振和静息 12 导联心电图的患者。排除标准是可能影响心电图的临床混杂因素，包括心肌瘢痕。高级心电图 (A-ECG) 分析包括常规心电图测量和幅度、派生的矢量心电图和极心电图测量以及波形复杂性的奇异值分解。1) 增加的 LVM 指数 (LVMI) 的 A-ECG 评分，和 2) 分别使用多变量逻辑回归得出健康志愿者中超过正常上限的整体壁厚指数 (GTI) 增加。将每个分数的曲线下面积 (AUC) 及其自举置信区间 (CI) 与常规 ECG-LVH 标准（包括康奈尔电压、康奈尔乘积和 Sokolow-Lyon 电压标准）进行比较。结果在 485 名患者（中位 [四分位距] 年龄 51 [38-61] 岁，54% 女性）中，51 名 (11%) 的 LVMI 增加，65 名 (13%) 的 GTI 增加。LVMI 增加（AUC [95% CI] 0.84 [0.78-0.90]）和 GTI 增加（0.80 [0.74-0.85]）的 A-ECG 评分不同，AUC 高于传统 ECG-LVH 标准（p < 0.001 所有）。结论在 A-ECG 的心电图表现中，LVMI 增加与 GTI 增加不同。在确定增加的 LVMI 和 GTI 方面，新的 A-ECG 评分优于传统的 LVH 心电图标准。

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The electrical determinants of increased wall thickness and mass in left ventricular hypertrophy.

INTRODUCTION Left ventricular hypertrophy (LVH), defined as an increased left ventricular mass (LVM), can manifest as increased wall thickness, ventricular dilatation, or both. Existing LVH criteria from the electrocardiogram (ECG) have poor sensitivity. However, it is unknown whether changes in wall thickness and mass, respectively, can be separately detected by the ECG. METHODS Patients undergoing cardiovascular magnetic resonance and resting 12-lead ECG were included. Exclusion criteria were clinical confounders that might influence the ECG, including myocardial scar. Advanced ECG (A-ECG) analysis included conventional ECG measures and amplitudes, derived vectorcardiographic and polarcardiographic measures, and singular value decomposition of waveform complexity. A-ECG scores for 1) increased LVM index (LVMI), and 2) increased global wall thickness index (GTI) beyond the upper limit of normal in healthy volunteers, respectively, were derived using multivariable logistic regression. The area under the curve (AUC) and its bootstrapped confidence interval (CI) for each score were compared to those of conventional ECG-LVH criteria including Cornell voltage, Cornell product, and Sokolow-Lyon voltage criteria. RESULTS Out of 485 patients (median [interquartile range] age 51 [38-61] years, 54% female), 51 (11%) had increased LVMI and 65 (13%) had increased GTI. The A-ECG scores for increased LVMI (AUC [95% CI] 0.84 [0.78-0.90]), and increased GTI (0.80 [0.74-0.85]) differed, and had a higher AUC than the conventional ECG-LVH criteria (p < 0.001 for all). CONCLUSIONS Increased LVMI differed from increased GTI in its electrocardiographic manifestation by A-ECG. New A-ECG scores outperform conventional ECG criteria for LVH in determining increased LVMI and GTI, respectively.

更新日期：2019-11-01

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