心电图钩形R波诊断继发孔型房间隔缺损的研究

The diagnosis value of rochetage pattern in inferior limb heads to the secundum atrail septal defect

目的研究心电图下壁导联R波顶端切迹诊断继发孔型房间隔缺损的价值。方法 116例单发继发孔型房间隔缺损患者,30例卵圆孔未闭者,50例正常对照组和7例多发继发孔型房间隔缺损患者,计算单发继发孔型房间隔缺损组、卵圆孔未闭组、多发继发孔型房间隔缺损组以及正常对照组心电图R波顶端切迹的发生率以及下壁导联R波顶端切迹诊断继发孔型房间隔缺损的敏感性和特异性。结果单发继发孔型房间隔缺损组中62.9%的患者至少1个导联出现R波切迹,15.5%的患者3个导联均存在切迹,发生率高于卵圆孔未闭组和正常对照组(p<0.001),多发继发孔型房间隔缺损组中所有患者均存在下壁导联R波切迹,至少1个导联出现R波切迹发生率为100%,高于单发继发孔型房间隔缺损组(p<0.001)。心电图下壁导联至少一个导联出现R波切迹诊断单发继发孔型房间隔缺损的敏感性和特异性分别为62.9%和93.8%,3个下壁导联均出现R波切迹诊断继发孔型房间隔缺损的敏感性和特异性为15.5%和100%。结论下壁导联R波顶端切迹在继发孔型房间隔缺损患者中发生率明显高于卵圆孔未闭者和正常对照者,可以作为诊断继发孔型房间隔缺损的参考指标。

Objective To test the value of the crochetage pattern （a notch near the apex of the R wave in electrocardiographic inferior limb leads） in detecting patients with a secundum atrail septal defect. Methods We searched for crochetage pattern in 116 patients with single secundum atrail septal defect,30 patient with foramen ovale,50 normal subjects and 7 patients with multiple secundum atrail septal defect. Results The electrocardiographic crochetage pattern was observed in 62.9% of preoperative patients with a secundum atrial septal defect in at least one inferior limb lead and was observed in 15.5% in all three inferior limb leads. The results were higher than the patent foramen ovale patients and normal subjects （p0.001）. The electrocardio graphic crochetage pattern was observed in all patients with multiple secundum atrial septal defects in at least one inferior limb lead and it was higher than patients with single secundum atrial septal defect（p0.001）. The sensitivity and specificity of the electrocardiographic crochetage patterns in at least one inferior limb lead in echocardiographically proven secundum atrial septal defects are 62.9% and 93.8%,respectively. The sensitivity and specificity of the electrocardiographic crochetage patterns in all inferior limb leads in echocardiographically proven secundum atrial septal defects are 15.5% and 100%,respectively. Conclusions The electrocardio graphic crochetage or notching pattern in inferior limb leads has a higher specificity for atrial septal defects than control subjects.