心电图新指标在肥厚型心肌病诊断中的应用

The new ECG hypertrophy indicators in the diagnosis of patients with hypertrophic cardiomyopathy

目的分析肥厚型心肌病患者的心电学特征和常规肥厚指标,并拟选取新指标观察其敏感性和特异性,与常规指标的关联性及优越性。方法肥厚型心肌病(HCM)组105例与正常对照组65例,予以常规12导联心电图及超声心动图检查。结果 HCM组的心电常规参数,临床异常特征比例及肥厚指标均比正常对照组高(p<0.01);方差分析:复极化异常中亚组之间均有明显差异;新指标RV3+SV1无梗阻性与梗阻性,心尖肥厚型均有统计学差异(p=0.017;p=0.038);ROC分析:当RV2+SV1取值2.0mV,敏感度56.2%,特异度90.8%,阳性预测值89.5%,阴性预测值56.3%;RV3+SV1取值2.48mV,敏感度57.1%,特异度92.3%,阳性预测值92.18%,阴性预测值56.19%。结论肥厚型心肌病较常人更易发生复极化异常和除极化异常,RV3/RV2+SV1优于所有传统肥厚指标,可作为一项较为特异性的诊断指标。

Objective To analyze the electrocardiogram features and general hypertrophy index of patients with hypertrophic cardiomyopathy, and intends to select a new index to study its sensitivity, specificity, relevance and superiority with the conventional indicators. Methods One hundred and five consecutive patients diagnozed HCM and 65 normal persons were enrolled in this study. Each subject finished ECG and Echocardiography. Results compared with the control group, ECG parameters, clinical abnormalities ratios and hypertrophy index is higher than the control group（p0.01）; ANOVA showed the differences of repolarization abnormalities among subgroups were siginifcant. New indicator RV3＋SV1 in HCM and HOCM,APH were statistically significant（p=0.017;p=0.038） ROC curve analysis revealed that when RV2＋SV1 valued of 2.0mV, its sensitivity was 56.2%, specificity was 90.8%, positive predictive value was 89.5%, negative predictive value was 56.3%; while RV3＋SV1 valued of 2.48mV,its sensitivity was 57.1%, specificity was 92.3%. The positive predictive value was 92.18%, negative predictive value was 56.19%. Conclusion HCM group are more likely to have depolarization and repolarization abnormalities. Because of their superiority, the new indicators of hypertrophy index RV2/RV3＋SV1 can be used as the specific markers.