心电图QRS波振幅参数对高血压性左室肥厚病情的评估价值及临床意义

Assessment value and clinical significance of electrocardiographic QRS wave amplitude parameters on hypertensive left ventricular hypertrophy

目的 探讨心电图QRS波振幅参数对高血压性左室肥厚(EH-LVH)患者病情的诊断价值,以期为临床制定治疗方案提供参考。方法 随机抽样选取96例于2021年1月至2022年1月就诊于我院的EH-LVH患者作为研究对象,入院后均行心电图及超声心动图检查,比较不同病情程度患者QRS波振幅参数[SV1+RV5振幅、所有导联QRS波群振幅之和(12∑QRSWA)、RⅠ+SⅢ振幅]、超声心动图指标[左心室后壁厚度(LVPWT)、室间隔厚度(IVST)、左心室质量指数(LVMI)、左心室射血分数(LVEF)],分析QRS波振幅参数与病情及超声心动图指标相关性,采用受试者工作特征曲线(ROC)分析其对EH-LVH病情的评估价值。结果 不同病情患者入院时SV1+RV5振幅、12∑QRSWA、RⅠ+SⅢ振幅比较:轻度>中度>重度(均P<0.05);不同病情患者入院时LVPWT、IVST、LVMI比较:轻度<中度<重度,LVEF比较:轻度>中度>重度(均P<0.05);SV1+RV5振幅、12∑QRSWA、RⅠ+SⅢ振幅与病情程度、LVPWT、IVST、LVMI呈负相关,与LVEF呈正相关(P<0.05);SV1+RV5振幅、12∑QRSWA、RⅠ+SⅢ振幅对中度EH-LVH诊断AUC分别为0.806、0.836、0.771,联合诊断AUC为0.887,对重度EH-LVH诊断曲线下面积(AUC)分别为0.835、0.856、0.802,联合诊断AUC为0.919,均优于单一指标诊断;与治疗前比较,治疗6个月后SV1+RV5振幅、12∑QRSWA、RⅠ+SⅢ振幅较高(P<0.05)。结论 心电图QRS波振幅参数对于EH-LVH病情程度具有较高评估价值,可为临床早期病情诊断、评估预后提供参考,以针对性制定干预方案,改善预后。

Objective To investigate the diagnostic value of electrocardiographic QRS wave amplitude parame-ters on the condition of patients with hypertensive left ventricular hypertrophy(EH-LVH),in order to provide a refer-ence for clinical formulation of treatment plans.Methods_Ninety-six patients with EH-LVH who visited our hospital from January 2021 to January 2022 were selected as study subjects and electrocardiography and echocardiography were performed after admission.The QRS wave amplitude parameters[SV1+RV5 amplitude,sum of QRS group ampli-tudes in all leads(12QRSWA),R I+S II amplitude]and echocardiographic parameters[left ventricular posterior wall thickness(LVPWT),septal thickness(IVST),left ventricular mass index(LVMI),left ventricular ejection fraction(LVEF)]were compared in patients with different degrees of disease,and the correlation between QRS wave amplitude parameters and disease and echocardiographic parameters was analyzed by ROC for the assessment of EH-LVH dis-ease.Results Comparison of SV1+RV5 amplitude,12ZQRSWA,R I+SIII amplitude at admission of patients with different conditions:mild>moderate>severe(P<0.05).Comparison of LVPWT,IVST,LVMI at admission of patients with different conditions:mild<moderate<severe,comparison of LVEF:mild>moderate>severe(P<0.05).SV1+RV5 amplitude,12ZQRSWA,and R I+SII amplitude were negatively correlated with the degree of disease,LVPWT,IVST,and LVMI,and positively correlated with LVEF(P<0.05);SV1+RV5 amplitude,12 ZQRSWA,and R I+S II amplitude had diagnostic AUCs of 0.806,0.836,and 0.771 for moderate EH-LVH,0.835,0.856,and 0.802 for severe EH-LVH,and 0.919 for combined AUC,respectively.The combined diagnostic AUC was 0.887,and the diagnostic AUC for severe EH-LVH was 0.835,0.856,and 0.802,respectively,and the combined diagnostic AUC was 0.919,all of which were better than the single index diagnosis;SV1+RV5 amplitude,12ZQRSWA,and R I+SII amplitude were higher after 6 months of treatment compared with those before treatment(P<0.05).Conclusion The QRS wave amplitude parameter of ECG has a high value in assessing the degree of EH-LVH disease,which provides a reference for early clinical diagnosis of the disease and assessment of prognosis,in order to formulate targeted intervention plans to improve the prognosis.