高血压患者心电图S_D波在诊断左心室肥厚中的价值

The value of the deepest S wave of electrocardiogram in the diagnosis of left ventricular hypertrophy in patients with hypertension

目的测试一种新的心电图诊断标准,提高诊断原发性高血压病合并左心室肥厚的准确性。方法以美国超声心动图学会对左心室质量测量作为标准,选取高血压病(HBP)合并左心室肥厚(LVH)患者129例,同期根据年龄、性别匹配高血压左心室正常组(109名)。同步记录12导联心电图,选取所有心电图导联中最深S波(S_D)为研究对象,与采用目前公认的LVH心电图标准Cornell和Sokolow-Lyon进行比较,计算心电图相关指标判断HBP合并LVH的ROC曲线及其曲线下面积(AUC),获得鉴别的最佳临界值。结果心电图S_D预测HBP合并LVH的敏感度、特异度及AUC分别为86.05%、81.65%、0.892;心电图S_D+Sv4显示最高的敏感度为88.37%。等效性检验显示单导联S_D的AUC较Cornell、Sokolow-Lyon及S_D+Sv4标准Z值均具有统计学差异(P<0.05)。心电图S_D诊断男性HBP合并LVH的AUC及敏感度、特异度分别为0.901、90.29%、75.34%,等效性检验均优于Cornell、Sokolow-Lyon及S_D+Sv4标准(P<0.05)。结论心电图S_D诊断HBP合并LVH,提高了其诊断的敏感性,优于Cornell和Sokolow-Lyon标准,值得临床推广。

Aim This study tested a new criteria for electrocardiogram to improve the accuracy of primary hypertension with left ventricular hypertrophy.Methods The study measured left ventricular mass according to the American Society of Echocardiography(ASE)standard.We selected 129 patients with hypertension(HBP)and left ventricular hypertrophy(LVH)diagnosed in our hospital.At the same time,the normal wall thickness group of hypertension was matched according to age and gender.It simultaneously recorded 12-lead ECG,selected the deepest S-wave(S_D)of all leads as the research object,and currently accepted LVH ECG criteria such as Cornell voltage and Sokolow-Lyon were used for comparison.Area under the curve(AUC)analysis was used for comparison of single and combined leads.Results The AUC,sensitivity,and specificity of SDpredicted HBP with LVH were 0.892,86.05%and81.65%,and S_D+Sv4 showed the highest sensitivity of 88.37%.The equivalence test showed that Z value of S_Dwas statistically different from that of Cornell,Sokolow-Lyon and S_D+Sv4(all P<0.05).The AUC,sensitivity and specificity of predicted male HBP with LVH were 0.901,90.29%and 75.34%.The equivalence test was superior to Cornell,Sokolow-Lyon and S_D+Sv4(all P<0.05).Conclusion The new criteria S_D to diagnose HBP with LVH improves the sensitivity of diagnosis,superior to Cornell and Sokolow-Lyon standards which is worthy of clinical promotion.