左心室肥厚心电图诊断标准分析

Comparison of Electrocardiographic Criteria for Diagnosis of Left Ventricular Hy pertrophy

目的 :对比左心室肥厚心电图诊断标准的敏感性和特异性 ,以评价不同标准的诊断价值。方法 :分析 3 64例原发性高血压患者的超声心动图及心电图检查结果。以超声心动图对患者左心室肥厚情况的检查结果为参照 ,求得不同心电图标准 (Sokolow Lyon标准、Cornell标准、Romhilt Estes评分、Framingham标准及Perugia标准 )诊断左心室肥厚的敏感性和特异性。结果 :5项心电图诊断标准的敏感性均 <5 0 % ;而特异性较高 ,除Perugia标准外 ,余 4项标准均 >90 %。Perugia标准的敏感性最高 41% ,特异性低 89% ;Sokolow Lyon标准的敏感性 2 2 %及特异性 93 %均较低。结论 :心电图诊断左心室肥厚的特异性高、敏感性稍差。Perugia标准是Cornell标准、左心室劳损改变、Romhilt Estes评分等标准有机的结合 ,因此提高了心电图诊断的敏感性 ,而特异性未受到明显影响。

Objective:To evaluate different standard echocardiogram criteria in their sens itivity and specificity for the diagnosis of left ventricular hypertrophy. Methods: We examined the findings on echocardiogram and echocardiography of 364 essential hypertensive subjects. Left ventricular hypertrophy diagnosed by echoc ardiography was used as references to test the sensitivity and specificity of di fferent echocardiogram criteria (Sokolow-Lyon criteria, Cornell crit eria, Romhilt-Estes score, Framingham criteria and Perugia score). Results: Sensitivity was<50% for all the 5 tested criteria, but specificity wa s higher(>90%) except the Perugia score. The Perugia score had a highest sensiti vity (41%) and a less specificity (89%). Sokolow-Lyon criteria showed both a lo w sensitivity (22%) and a low specificity (93%). Conclusions: Echocardiogram is a specific, but not a sensitive tool for diagnosi s of left ventricular hypertrophy in subjects with essential hypertension. Howev er, an increased sensitivity of standard echocardiogram for detection of left ve ntricular hypertrophy can be achieved by the Perugia score, which incorporates C ornell voltage,Romhilt-Estes and LV strain.This combination improves echocardi ogram specificity,whereas the specificity is not affected.