心电图Cornell电压预测左室肥厚的逆转

Predictive value of electrocardiographic Cornell Voltage change in patients with regression of left ventricular hypertrophy

目的探讨心电图Cornell电压变化率对左心室肥厚(LVH)逆转的预测价值。方法根据心电图基线及一年后结果,将研究对象分为3组,Cornell电压增长组(A组,增长≥25%);无变化组(B组,变化<25%);减少组(C组,减少≥25%)。观察3组间左室质量(LVM)变化、血压变化及新发心脑血管事件并进一步比较电压变化率与LVM变化率之间的关系。采用受试者工作特征(ROC)曲线分析Cornell电压变化率对LVH逆转的预测价值。结果在电压减少组,LVM绝对值、变化率降低最为明显(-45.9g±42.0gvs.-13.4g±37.0gvs.48.6g±37.4g,p<0.01;-19.0%±17.5%vs.-4.4%±16.3%vs.23.8%±19.0%,p<0.01),收缩压、舒张压较基线明显下降,新发心脑血管事件亦最少。相关分析显示,电压变化率与LVM变化率显著相关(r=0.780,p<0.01),ROC曲线分析显示曲线下面积0.867,最佳诊断分界点为-25.5%,此时敏感性75.0%,特异性85.5%。结论心电图Cornell电压变化率能较好预测LVH逆转,可作为经济简便的手段应用于LVH患者的随访。

Objective To explore the predictive value of electrocardiographic（ECG） Cornell voltage change in patients with regression of left ventrieular hypertrophy （LVH）. Methods According to the baseline and year-1 ECGs, all subjects were divided into three groups, progression of Cornell voltage （group A, ≥25% progression） ; no significant changes of Cornell voltage（group B,〈25% changes）; decrease in Cornell voltage （group C, ≥25% decrease ）. The changes of left ventricular mass（LVM）, blood pressure（BP） and the new cardiovascular disease （CVD） events were observed, further more, we compared the relationship between the rates of change of Cornell voltage and LVM. Reeeiver operating characteristic （ROC） analysis was used to assess the predictive value of the rate of Cornell voltage change in patients with regression of LVM. Results Compared with patients in group A and B, patients in group C had greatest absolute and percent reductions in LV mass （-45.9g±42.0g Vs. - 13.4g±37.0g vs. 48.6g±37.4g, p 〈0.01; -19.0%±17.5% vs. -4.4%±16.3% vs. 23.8%± 19.0%, p 〈0.01）, greatest decreases in both systolic and diastolic pressure, and lowest CVD incidence; correlation analysis showed that the rate of ehange of Cornell voltage was significantly correlated with the rate of change of LVM （r=0.780, p〈0.01 ）. The optimal cutoff value in predicting regression of LVH was ≥25% decrease in Cornel/ voltage （sensitivity 75.5%, specificity 85.5%, AUC 0.867）. Conclusions The rate of Cornell voltage can prediet the change of LVM, we can use ECG in follow-up as an economy, simple method.