中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2010年
4期
346-349
,共4页
赵勤华%徐希奇%荆志成%孙明利%代立志%吴文汇%蒋鑫%何晶%李云
趙勤華%徐希奇%荊誌成%孫明利%代立誌%吳文彙%蔣鑫%何晶%李雲
조근화%서희기%형지성%손명리%대립지%오문회%장흠%하정%리운
高血压,肺性%心电描记术%血液动力学过程
高血壓,肺性%心電描記術%血液動力學過程
고혈압,폐성%심전묘기술%혈액동역학과정
Hypertension,pulmonary%Electrocardiography%Hemodynamic processes
目的 参照右心导管检查结果,评价常规12导联心电图在肺动脉高压诊断中的应用价值.方法 入选超声心动图估测肺动脉收缩压≥36 mm Hg(1 mm Hg=0.133 kPa)的64例疑诊肺动脉高压患者为研究对象,右心导管检查前30 min行12导联心电图检查.根据右心导管检查结果排除肺动脉高压者26例,确诊肺动脉高压者38例(特发性肺动脉高压23例,结缔组织病相关性肺动脉高压15例).比较两组间心电图参数差异.通过ROC曲线计算心电图各指标诊断肺动脉高压的敏感性、特异性、阳性预测值及阴性预测值.采用Spearman相关性计算肺动脉高压组心电图参数与血液动力学指标相关性.结果 心电图诊断右心室肥大的各指标在肺动脉高压组中的发生率显著高于排除肺动脉高压组.Ⅰ导联S波振幅＞0.21 mV、QRS电轴＞87°、R_(v1) + S_(v5)＞0.76 mV诊断肺动脉高压的敏感性分别为89%、86%、84%,特异性分别为81%、92%、83%.采用Spearman相关性分析显示,QRS电轴与肺动脉平均压的相关性最高(r=0.75,P＜0.001);R_(v1) + S_(v5)与肺血管阻力的相关性最高(r=0.74,P＜0.001);R_(v1) + S_(v5)和I导联S波振幅与心指数相关性较高(r=-0.62,P＜0.001).结论 常规12导联心电图检查在肺动脉高压筛查中有重要价值,Ⅰ导联S波振幅＞0.21 mV、QRS电轴＞87°、R_(v1) + S_(v5)＞0.76 mV等右心室肥大征象时应考虑到肺动脉高压可能.QRS电轴、R_(v1) + S_(v5)以及Ⅰ导联S波振幅对评估肺动脉高压患者血液动力学受损的严重程度有临床意义.
目的 參照右心導管檢查結果,評價常規12導聯心電圖在肺動脈高壓診斷中的應用價值.方法 入選超聲心動圖估測肺動脈收縮壓≥36 mm Hg(1 mm Hg=0.133 kPa)的64例疑診肺動脈高壓患者為研究對象,右心導管檢查前30 min行12導聯心電圖檢查.根據右心導管檢查結果排除肺動脈高壓者26例,確診肺動脈高壓者38例(特髮性肺動脈高壓23例,結締組織病相關性肺動脈高壓15例).比較兩組間心電圖參數差異.通過ROC麯線計算心電圖各指標診斷肺動脈高壓的敏感性、特異性、暘性預測值及陰性預測值.採用Spearman相關性計算肺動脈高壓組心電圖參數與血液動力學指標相關性.結果 心電圖診斷右心室肥大的各指標在肺動脈高壓組中的髮生率顯著高于排除肺動脈高壓組.Ⅰ導聯S波振幅＞0.21 mV、QRS電軸＞87°、R_(v1) + S_(v5)＞0.76 mV診斷肺動脈高壓的敏感性分彆為89%、86%、84%,特異性分彆為81%、92%、83%.採用Spearman相關性分析顯示,QRS電軸與肺動脈平均壓的相關性最高(r=0.75,P＜0.001);R_(v1) + S_(v5)與肺血管阻力的相關性最高(r=0.74,P＜0.001);R_(v1) + S_(v5)和I導聯S波振幅與心指數相關性較高(r=-0.62,P＜0.001).結論 常規12導聯心電圖檢查在肺動脈高壓篩查中有重要價值,Ⅰ導聯S波振幅＞0.21 mV、QRS電軸＞87°、R_(v1) + S_(v5)＞0.76 mV等右心室肥大徵象時應攷慮到肺動脈高壓可能.QRS電軸、R_(v1) + S_(v5)以及Ⅰ導聯S波振幅對評估肺動脈高壓患者血液動力學受損的嚴重程度有臨床意義.
목적 삼조우심도관검사결과,평개상규12도련심전도재폐동맥고압진단중적응용개치.방법 입선초성심동도고측폐동맥수축압≥36 mm Hg(1 mm Hg=0.133 kPa)적64례의진폐동맥고압환자위연구대상,우심도관검사전30 min행12도련심전도검사.근거우심도관검사결과배제폐동맥고압자26례,학진폐동맥고압자38례(특발성폐동맥고압23례,결체조직병상관성폐동맥고압15례).비교량조간심전도삼수차이.통과ROC곡선계산심전도각지표진단폐동맥고압적민감성、특이성、양성예측치급음성예측치.채용Spearman상관성계산폐동맥고압조심전도삼수여혈액동역학지표상관성.결과 심전도진단우심실비대적각지표재폐동맥고압조중적발생솔현저고우배제폐동맥고압조.Ⅰ도련S파진폭＞0.21 mV、QRS전축＞87°、R_(v1) + S_(v5)＞0.76 mV진단폐동맥고압적민감성분별위89%、86%、84%,특이성분별위81%、92%、83%.채용Spearman상관성분석현시,QRS전축여폐동맥평균압적상관성최고(r=0.75,P＜0.001);R_(v1) + S_(v5)여폐혈관조력적상관성최고(r=0.74,P＜0.001);R_(v1) + S_(v5)화I도련S파진폭여심지수상관성교고(r=-0.62,P＜0.001).결론 상규12도련심전도검사재폐동맥고압사사중유중요개치,Ⅰ도련S파진폭＞0.21 mV、QRS전축＞87°、R_(v1) + S_(v5)＞0.76 mV등우심실비대정상시응고필도폐동맥고압가능.QRS전축、R_(v1) + S_(v5)이급Ⅰ도련S파진폭대평고폐동맥고압환자혈액동역학수손적엄중정도유림상의의.
Objectives To analyze the diagnostic value of electrocardiogram (ECG) in patients with pulmonary artery hypertension (PAH) confirmed by right-heart catheterization (RHC).Methods A total of 64 patients with suspected PAH[sPAP≥36 mm Hg(1 mm Hg =0.133 kPa) estimated by echocardiography]were enrolled in this study.All patients were examined by 12-lead ECG within half an hour before RHC.Results PAH was excluded in 26 patients and confirmed in 38 patients.ECG analysis showed that S amplitude＞0.21 mV in lead Ⅰ ,QRS axis＞87°,R_(v1) + S_(v5)＞0.76 mV were good parameters for diagnosing PAH with sensibility and specificity of 89%,81%;86%,92%;84%,83%,respectively.QRS axis was positively correlated with mean pulmonary artery pressure (mPAP) (r = 0.75,P＜0.001),R_(v1) + S_(v5) was positively correlated with pulmonary vascular resistance (PVR) (r =0.74,P＜0.001),R_(v1) + S_(v5) and S amplitude in lead Ⅰ was negatively correlated with cardiac index (CI)(r = -0.62,P ＜0.001).Conclusion ECG combined with echocardiography are adequate screening tools to rule out the presence of PAH.QRS axis,R_(v1) + S_(v5) and S amplitude in lead Ⅰ were significantly correlated with hemodynamic parameters derived from RHC in PAH patients.
