心电图诊断左室肥厚标准的评价

Evaluation of the diagnosis of left ventricular hypertrophy with ECG

目的 :以超声心动图 (UCG)测量的室壁厚度及心肌质量为标准 ,评价心电图 (ECG)诊断左室肥厚 (LVH)的敏感性和特异性 ,探讨更合理的诊断标准。方法 :收集 15 1例高血压或肥厚性心肌病病例 ,比较其ECG、UCG结果 ,计算ECG诊断的敏感性及特异性。计算LVH患者的电压均值 ,用界值移动法寻找ECG诊断的最佳电压界值。结果 :ECG诊断LVH 36例。以室壁厚度为标准 ,ECG诊断的敏感性为 4 1.1% ,特异性为 86 .3% ,诊断符合率 72 .2 % ;以心肌质量指数为标准 ,其敏感性为 34.9% ,特异性为 84 .3% ,诊断符合率 6 3.6 %。电压标准中Rv5+Sv1标准应用频率最高 ,LVH病例的电压均值为 3.74 2 (男 ) / 3.4 2 7(女 )mV ,界值移动法获得较好诊断准确率的为Rv5+Sv1>4 .0 (男 ) / 3.5 (女 )mV。结论 :ECG诊断LVH的敏感性低 ,特异性较好。以超声测得室壁厚度和心肌质量指数标准对LVH的检出率无显著差异 ,对ECG诊断的评价效果近似。改变Rv5+Sv1标准界值对ECG诊断准确性的提高无太大意义。

Objective:To evaluate the sensitivity and specificity of ECG diagnosis of left ventricular hypertrophy (LVH) and to formulate a better criterion. Methods: 151 hypertension or hypertrophic myocardiopathic patients were studied using echocardiography LVMI≥134 (male), 110 (female) g/cm 2 and the thickness of the ventricular wall (IVS or LVPW≥12 mm) as reference. If LVH is also diagnosed with ECG, it is truly positive, otherwise it is false negative. The sensitivity, specificity and accuracy of ECG were calculated on the basis of the above results. Our purpose is to find a better criteria by criteria moving method. Results: 34 patients were diagnosed as LVH by ECG. There are 63 patients whose LVMI≥134(male)/110(female)g/cm 2, and 54 patients whose IVS or LVPW≥12 mm. The specificity of ECG diagnosis referring to IVS/LVPW was 86.3%,the sensitivity was 41.1%, and the accuracy was 72.2%. Referring to LVMI, they were 34.9%, 84.3% and 63.6%, respectively. Rv 5+Sv 1 was the most frequently used. The average value of voltage was 3.742 (male)/3.472 (female) mV in LVH patients. Among the criteria 4.5、4.3、4.0、3.7、3.5、3.3, 2.7 mV, 4.0(m)/3.5(f)got the best diagnosis accuracy. Conclusion: Using ECG to diagnose LVH has low sensitivity and a better specificity. There is no significance in prevalence either referring to IVS/LVPW or LVMI, and their effects in the evaluation of ECG are the same. Changing its criteria cannot improve the accuracy of ECG diagnosis.