胸导联低一肋QRS形态对左束支传导阻滞合并左心室肥大的诊断价值

Diagnostic value of QRS morphology recorded from one interspace lower in left bundle branch block with left ventricular hypertrophy

目的探讨胸导联低一肋间（V1-V6）心电图QRS形态对完全性左束支传导阻滞合并左心室肥大的诊断价值。方法对心电图示完全性左束支传导阻滞患者加作V1-V6心电图，依据超声心动描记术诊断分为左束支传导阻滞合并左心室肥大（观察组，n=57）与单纯完全性左束支传导阻滞组（对照组，n=49），分析心电图各项指标。结果观察组V5或V6呈Rs、RS、rs、或rsr′型以及V5呈Rs、rs、rS、rSr′型可支持左心室肥大的诊断（P〈0．05）；与Rv6＋SV2≥4，5mV、SV2〉3.5mV和QRS时间≥0．15s比较，Rv6≥Rv、5Rv6≥Rv5、的敏感性较高（P〈0．05）；与Rv6＋Sv2≥4．5mV及Sv2〉3．5mV比较，Rv6≥Rv6和Rv5≥Rv5特异性较高（P〈0．05或P〈0．01）。结论V1～V6QRS形态的特征变化可能提高对左心室肥大诊断的敏感性、特异性及准确性。

Objective To evaluate diagnostic value of QRS morphology recorded from one inter- space lower in left ventricular hypertrophy （LVH） with left bundle branch block （LBBB）. Methods 49 patients with LBBB （ group A） and 57 patients with both LBBB and LVH on echocardiogram（ LVH ）（group B ） were enrolled. In addition to routine precordial lead, electrocardiogram was recorded from one interspace lower. Results Rs .RS.rs.or rsr＇ in V5 or V6 and Rs .rs.rS .rSr＇ in V5 appeared more in group B （P〈0.05）. In diagnosis of LVH, Rv6≥Rv5, and Rv6≥Rv5, were more sensitive than Rv6＋Sv2 ~〉4.5mV, Sv2≥3.5mV and QRS interval≥0.15s （P〈0.05）, Rv6≥Rv5 and Rv5≥Rv5 were more sp.ecific than Rv6＋Sv2≥ 4.5mV and Sv2, 〉3.5mV （P〈0.05 or P〈0.01 ）. Conclusion QRS morphology from one interspace lower may improve diagnostic sensitivity, specificity and accuracy for LVH.