左心室肥厚的心电图诊断新标准在中国人群中的诊断价值及其影响因素

Diagnostic efficacy and influencing factors of a new standard for diagnosis of left ventricular hypertrophy in Chinese population

目的在中国人群中验证S_(D)+SV_(4)标准对左心室肥厚(left ventricular hypertrophy,LVH)的诊断效能,并分析影响其诊断准确性的因素。方法纳入2017年1月~2019年12月期间就诊的高血压患者477例。以超声心动图参数计算的左心室质量指数(left ventricular mass index,LVMI)作为诊断LVH的金标准。使用ROC曲线评估S_(D)+SV_(4)、RavL+SV_(3)和SV_(1)+RV_(5)/RV_(6)标准诊断LVH的效能。使用多因素Logistic回归分析评估影响S_(D)+SV_(4)标准诊断LVH准确性的因素。结果基于LVMI,共有139例(29.1%)患者诊断为LVH。女性中,S_(D)+SV_(4)标准的曲线下面积(area under curve,AUC)明显高于RavL+SV_(3)(0.847 vs.0.728,P<0.05)和SV_(1)+RV_(5)/RV_(6)标准(0.847 vs.0.706,P<0.05),且其灵敏度(79.2%)和特异度(94.4%)也高于其他两种诊断标准;而在男性中,S_(D)+SV_(4)标准与其他两种标准的AUC无显著统计学差异。调整其他因素后,仅左室射血分数(OR=0.930,95%CI 0.902~0.961,P<0.01)在S_(D)+SV_(4)标准和金标准诊断与LVH一致性方面存在显著统计学差异。结论新提出的S_(D)+SV_(4)标准在诊断LVH方面优于传统心电图标准诊断。左室射血分数降低是影响其诊断LVH准确性的独立影响因素。

AIM To verify the diagnostic efficacy of S_(D)+SV_(4) criterion for left ventricular hypertrophy(LVH)in the Chinese population and to analyze the factors influencing its diagnostic accuracy.METHODS Patients with hypertension who were treated in our hospital from January 2017 to December 2019 were included.The left ventricular mass index(LVMI)calculated with echocardiographic parameters was used as the gold standard for diagnosing LVH in this study.The receiver operating curve(ROC)curve was used to evaluate the efficacy of S_(D)+SV_(4),RavL+SV_(3) and SV_(1)+RV_(5)/RV_(6) criteria in diagnosing LVH.Moreover,multivariate logistic regression analysis was used to evaluate the factors influencing the accuracy of the S_(D)+SV_(4) standard in diagnosing LVH.RESULTS A total of 477 patients were included in this study,with an average age of 59±14 years.Based on LVMI,139(29.1%)patients were diagnosed with LVH.In women patients,the area under curve(AUC)of the S_(D)+SV_(4) criterion was significantly higher than those of the RavL+SV_(3)(0.847 vs.0.728,P<0.05)and SV_(1)+RV_(5)/RV_(6) criteria(0.847 vs.0.706,P<0.05),and its sensitivity(79.2%)and the specificity(94.4%)were also higher than those of the other two diagnostic criteria.In men patients,there were no significant difference between the AUC of S_(D)+SV_(4) criterion and the other two criteria.After adjusting for other factors,only the left ventricular ejection fraction(LVEF)(OR=0.930,95%CI 0.902~0.961,P<0.01)had significant differences in the consistency of the S_(D)+SV_(4) criterion and the gold standard in the diagnosis of LVH.CONCLUSION The newly proposed S_(D)+SV_(4) standard is better than the traditional electrocardiogram standard in diagnosing LVH.Decreased LVEF is an independent factor for the accuracy in diagnosing LVH.