心电图ST-T改变对高血压患者左室壁增厚的诊断意义

Significance of electrocardiographic ST-T changes in the diagnosis of left ventricular wall thickening in patients with hypertension

目的:为了提高心电图诊断左室壁增厚的准确性,探讨心电图不同导联ST-T改变对高血压患者左室壁增厚的诊断意义。方法:回顾性分析2018年3月—2019年3月在汕头大学医学院第一附属医院心内科住院的高血压患者364例,其中男性164例,女性200例,年龄20~93岁,平均(57.84±13.52)岁。将心电图各诊断标准以及不同导联ST-T改变诊断左室壁增厚的结果,与心脏超声心动图诊断结果比较,对比各诊断条件的敏感性、特异性和准确性。结果:Cornell标准联合V5/V6导联T波改变诊断左室壁增厚的ROC曲线下面积(AUC)最大,诊断室间隔增厚、左室后壁增厚的AUC分别为0.731和0.766。Cornell标准联合TV5/V6倒置诊断左室壁增厚的特异性、准确性分别为99.41%、97.30%,高于所有单一诊断指标,敏感性为18.56%,高于RV5/V6≥2.6 mV的指标。结论:Cornell标准联合V5/V6导联T波改变对左室壁增厚的诊断能力大于单一诊断标准,Cornell标准联合TV5/V6倒置诊断左室壁增厚的特异性和准确性优于单一诊断标准。

Objective:In order to improve the accuracy of electrocardiogram in diagnosing left ventricular wall thickening,the significance of ST-T changes in different leads of electrocardiogram in the diagnosis of left ventricular wall thickening in hypertensive patients was explored.Methods:From March 2018 to March 2019,364 patients with hypertension admitted to the Department of Cardiology,the First Affiliated Hospital of Medical College of Shantou University were retrospectively analyzed,including 164 males and 200 females,aged 20-93 years,average(57.84±13.52)years old.The diagnostic criteria of the electrocardiogram and the ST-T changes in different leads to diagnose left ventricular wall thickening were compared with the diagnostic results of echocardiography to compare the sensitivity,specificity,and accuracy of each diagnostic condition.Results:The Cornell standard combined with V5/V6 lead T wave changes had the largest AUC for diagnosing left ventricular wall thickening.The AUCs for the diagnosis of thickened ventricular septum and thickened left ventricular posterior wall were 0.731 and 0.766,respectively.The specificity and accuracy of Cornell standard combined with TV5/V6 inversion in the diagnosis of left ventricular wall thickening were 99.41%and 97.30%,which were higher than all single diagnostic indicators,and the sensitivity was 18.56%,which was higher than the indicator of RV5/V6≥2.6 mV.Conclusion:The Cornell standard combined with V5/V6 lead T wave changes are more capable of diagnosing left ventricular wall thickening than a single diagnostic criterion.The Cornell standard combined with TV5/V6 inversion is more specific and accurate than a single diagnosis standard of left ventricular wall thickening.