心电图SV_(3)+RV_(5)/V_(6)标准在诊断马拉松跑者左心室肥厚中的价值  

The value of the electrocardiogram SV_(3)+RV_(5)/V_(6)criteria in the diagnosis of left ventricular hypertrophy in marathon runners

作　　者：杨盼 江姝 葛志祥[1] 柯海燕[2] 徐敏[1] 邢伟[3] YANG Pan;JIANG Shu;GE Zhixiang;KE Haiyan;XU Min;XING Wei(Echocardiography Room,the Third Affiliated Hospital of Soochow University,the First People's Hospital of Changzhou,Suzhou,Jiangsu,213003,China;Department of Cardiology,the Third Affiliated Hospital of Soochow University,the First People's Hospital of Changzhou,Suzhou,Jiangsu,213003,China;Department of Imaging,the Third Affiliated Hospital of Soochow University,the First People's Hospital of Changzhou,Suzhou,Jiangsu,213003,China)

机构地区：[1]苏州大学附属第三医院(常州市第一人民医院)心超室,江苏常州213003 [2]苏州大学附属第三医院(常州市第一人民医院)心内科 [3]苏州大学附属第三医院(常州市第一人民医院)影像科

出　　处：《临床心血管病杂志》2024年第1期57-63,共7页Journal of Clinical Cardiology

基　　金：常州市卫健委青年项目(No:QN202208);常州市“十四五”卫生健康高层次人才培养项目(No:2022260)。

摘　　要：目的:测试心电图SV_(3)+RV_(5)/V_(6)标准诊断马拉松跑者左心室肥厚(LVH)的价值。方法:选取常州市参加A1类认证赛事达标的马拉松跑者112名,收集一般临床信息。采用心电自动分析仪进行心电图检查,超声心动图仪获取左心室的实时三维超声心动图(RT-3DE)图像,计算左心室质量指数(LVMI)。根据美国超声心动图学会诊断LVH的LVMI标准,将受试马拉松跑者分为LVMI正常组(96例)及LVH组(16例)。按性别分层,使用多元线性回归分析心电图SV_(3)+RV_(5)/V_(6)标准与马拉松跑者LVH的相关性,并与Cornell标准(SV_(3)+RaVL)、改良Cornell标准(SD+RaVL)、Sokolow-Lyon标准(SV1+RV_(5)/V_(6))及Peguero-Lo Presti标准(SD+SV4)进行比较。绘制受试者操作特征(ROC)曲线并筛选出最佳诊断效能的心电图标准。结果:在所有马拉松跑者中,心电图标准SV_(3)+RV_(5)/V_(6)、SV1+RV_(5)/V_(6)、SV_(3)+RaVL、SD+RaVL及SD+SV4识别马拉松跑者LVH具有统计学意义(均P<0.05)。按性别分层,在无校正及校正混杂因素(年龄、BMI及高血压史)后,线性回归分析显示,与LVMI正常组相比,心电图标准SV_(3)+RV_(5)/V_(6)及SV_(3)+RaVL在LVH组增高,均差异有统计学意义(均P<0.05)。ROC分析显示,SV_(3)+RV_(5)/V_(6)标准的曲线下面积(AUC)大于SV_(3)+RaVL标准(0.879 vs 0.800,P<0.05)。曲线拟合显示,马拉松跑者心电图SV_(3)+RV_(5)/V_(6)值随LVMI的增加逐渐增加,二者呈近似的线性正相关。结论:心电图SV_(3)+RV_(5)/V_(6)标准与马拉松跑者LVH相关。Objective To assess the value of electrocardiogram(ECG)SV_(3)+RV_(5)/V_(6)criteria for diagnosing left ventricular hypertrophy(LVH)in marathons.Methods A total of 112 marathon runners who met the requirements for"Class A1"events certified by the Chinese Athletics Association in Changzhou City were selected,and their general clinical information was collected.ECG examinations were performed using Cardimax Electrocardiograph Automatic Analyser.Real-time 3-dimensional echocardiography(RT-3DE)images of the left ventricle were performed using an echocardiography system to calculate the left ventricular mass index(LVMI).According to the LVMI criteria of the American Society of Echocardiography for the diagnosis of LVH,the participants were divided into the LVMI normal group(n=96)and the LVH group(n=16).The correlation between the ECG SV_(3)+RV_(5)/V_(6)criteria and LVH in marathon runners was analysed using multiple linear regression stratified by sex and compared with the Cornell(SV_(3)+RaVL),modified Cornell(SD+RaVL),Sokolow-Lyon(SV1+RV_(5)/V_(6))and Peguero-Lo Presti(SD+SV4)criteria.The receiver operating characteristic(ROC)curves were drawn and the ECG criteria with the best diagnostic efficiency were selected.Results In all marathon runners,the ECG parameters SV_(3)+RV_(5)/V_(6),SV1+RV_(5)/V_(6),SV_(3)+RaVL,SD+RaVL,and SD+SV4 were able to identify LVH(all P<0.05).When stratified by sex,linear regression analysis revealed that a significantly higher number of ECG SV_(3)+RV_(5)/V_(6)criteria were evident in the LVH group than in the LVMI normal group(P<0.05),both with no adjustment and after adjustment(including age,body mass index and history of hypertension).ROC analysis showed that the area under the ROC curve(AUC)of ECG SV_(3)+RV_(5)/V_(6)criteria was higher than that of SV_(3)+RaVL criteria(0.879 vs 0.800,P<0.05).Additionally,curve fitting showed that the ECG SV_(3)+RV_(5)/V_(6)values increased with increasing LVMI in marathon runners,exhibiting a nearly linear positive correlation.Conclusion The ECG SV_(3)+RV_

关 键 词：左心室肥厚 马拉松跑者 心电图 SV_(3)+RV_(5)/V_(6)标准 

分 类 号：R542.2[医药卫生—心血管疾病]