心电图诊断左室肥厚的可靠性

The Accuracy of Diagnostic Criteria of Left Ventricular Hypertrophy by Electrocardiography

目的 根据 2 0 0 3年欧洲高血压治疗指南 ,以超声左室重量指数LVMI作为诊断左室肥厚的参考标准 ,探讨心电图Sokolow lyon指数和Cornell指数诊断高血压左室肥厚的敏感性和特异性。方法 2 80例高血压病患者 ,全部均经心超、心电图检查。按照心超左室重量指数 ,男性LVMI >12 5 g/m2 ,女性LVMI >110 g/m2 作为左室肥厚诊断标准 ,根据心超阳性进行分组。分别计算心电图Sokolow lyon指数和Cornell指数诊断左室肥厚的敏感性和特异性 ,采用 χ2 检验判断二种方法的敏感性有无差异。结果 Cornell指数敏感性 3 2 % ,特异性 94% ,Sokolow lyon指数敏感性 2 2 % ,特异性 96%。经 χ2检验 ,二者间敏感性具有统计学差异。二者联合应用 ,则左室肥厚的检出率达 3 5 %。结论 Sokolow lyon指数简便易行 ,但敏感性差 ;Cornell指数敏感性提高 ,但方法繁琐 ,需要计算机检测或放大测量 。

Objective To evaluate the accuracy of two ECG criteria (Cornell and Sokolow-lyon) in diagnose of left ventricular hypertrophy (LVH). Methods Two hundred eighty cases of essential hypertension were allocated in 2 groups according to findings in echocardiography, LVH were defined by left ventricular mass index(LVMI)>125 g/m 2 in men and LVMI >110 g/m 2 in women. QRS voltage was calculated by Sokolow-lyon criteria(SV 1+RV 5/or RV 6>38 mm) and Cornell product criteria [(RaVL+SV 3)×QRS duration>2440 mm×mec] in men and [(RaVL+SV 3+6)×QRS duration>2440 mm×mec] in women. The sensitivity and specificity of them were calculated. Results The sensitivity is 22% by Sokolow-lyon and 32% by Cornell for the diaguosis of LVH with the specificity of 96% and 94%, respectively. The sensitivity of Sokolow-lyon and Cornell criteria combination is 35%. Conclusion The sensitivity of Sokolow-lyon and Cornell criteria in diagnosis of LVH is low although the specificity is quite satisfied.