左心室肥厚伴肢体导联低电压在心脏淀粉样变中的诊断价值  

Diagnostic value of left ventricular hypertrophy with limb lead low voltage in cardiac amyloidosis

作　　者：李敏 孙显东 王宇楠 王珂[2] Li Min;Sun Xiandong;Wang Yunan;Wang Ke(Department of Cardiology,Chifeng Municipal Hospital,Chifeng Clinical Medical College of Inner Mongolia Medical University,Chifeng 024099,China;Department of Cardiology,The First Affiliated Hospital of Dalian Medical University,Dalian 116011,China)

机构地区：[1]内蒙古医科大学赤峰临床医学院,赤峰市医院心内科,赤峰024099 [2]大连医科大学附属第一医院心内科,大连116011

出　　处：《中华心力衰竭和心肌病杂志（中英文）》2024年第2期89-94,共6页Chinese Journal of Heart Failure and Cardiomyopathy

摘　　要：目的评估超声心动图检查左心室增厚(LVH)与心电图检查肢体导联低电压在心脏淀粉样变(CA)中的诊断价值。方法收集自2000年11月至2018年11月在大连医科大学附属第一医院住院,超声心动图检查提示LVH,伴或不伴有心动图肢体导联低电压的患者,根据出院诊断分为确诊CA(组1)、原发性非梗阻性肥厚型心肌病(HCM)(组2)、中度或重度主动脉瓣狭窄(AS)(组3)、高血压性心脏病(组4)及可疑CA(组5)共5组。将组2、组3和组4患者合并为非CA患者,与组1患者比较,评估超声心动图检查LVH和心电图检查肢体导联低电压对CA的诊断价值。将组5(可疑CA患者)与组1(确诊CA患者)进行比较,评估两组患者临床特征的差异。结果本研究共纳入了128例患者,确诊CA(组1)患者16例,原发性非梗阻性HCM(组2)患者32例,中度或重度AS(组3)患者30例,高血压性心脏病(组4)患者30例,可疑CA(组5)患者20例。以超声心动图检查LVH合并心电图肢体导联低电压作为初步诊断CA的判断标准,诊断灵敏度、特异度、准确率、漏诊率、误诊率、阳性预测值、阴性预测值、阳性似然比、阴性似然比分别为81.2%、97.8%、95.4%、18.8%、2.2%、86.7%、96.8%、36.9、0.2。组1和组5患者心电图和超声心动图指标比较差异无统计学意义(P均>0.05)。结论以“电”与“结构”不匹配现象,作为初步诊断具有LVH的CA的指标较可靠,灵敏度和阳性预测值均较高(>80%),有利于临床上高度怀疑CA患者的诊断,减少漏诊率;该判断标准的特异度和阴性预测值更高(均>95%),具有很好的排除诊断和减少误诊率的临床实用价值。Objective To evaluate the diagnostic value of left ventricular hypertrophy(LVH)by echocardiography and limb lead low voltage by electrocardiogram(ECG)in cardiac amyloidosis(CA).Methods Patients hospitalized in the First Affiliated Hospital of Dalian Medical University from November 2000 to November 2018 with echocardiography indicating LVH with or without limb lead low voltage on ECG were enrolled in this analysis.According to discharge diagnosis,patients were divided into 5 groups:confirmed CA(group 1),primary non-obstructive hypertrophic cardiomyopathy(HCM)(group 2),moderate or severe aortic stenosis(AS)(group 3),hypertensive heart disease(group 4)and suspected CA(group 5).Patients in groups 2,3,and 4 were combined as non-CA patients and compared with patients in group 1 to evaluate the diagnostic value of LVH by echocardiography and limb lead low voltage by electrocardiogram for CA.Group 5(suspected CA)was compared with group 1(confirmed CA)to assess differences in clinical features.Results A total of 128 patients were enrolled in this study,including 16 patients with confirmed CA(group 1),32 with primary non-obstructive HCM(group 2),30 with moderate or severe AS(group 3),30 with hypertensive heart disease(group 4),and 20 with suspected CA(group 5).Based on the criteria of LVH on echocardiogram combined with limb lead low voltage on ECG for preliminary diagnosis of CA,the diagnostic sensitivity,specificity,accuracy,missed diagnosis rate,misdiagnosis rate,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio were 81.2%,97.8%,95.4%,18.8%,2.2%,86.7%,96.8%,36.9,0.2,respectively.There were no significant differences in ECG and echocardiographic parameters(all P>0.05).Conclusion The mismatch between"electricity"and"structure"is a reliable indicator for the preliminary diagnosis of CA with LVH,and the sensitivity and positive predictive value are higher(>80%),which is conducive to the diagnosis of patients with high suspicion of CA and reduce the rate of missed diagno

关 键 词：心脏淀粉样变 左心室肥厚 肢体导联低电压 诊断 鉴别诊断 

分 类 号：R541[医药卫生—心血管疾病]