본문 바로가기
KERD
논문KCI 등재후보

한국인 코호트에서 좌심실 비후를 진단하기 위한 심전도의 정확성

The Accuracy of Electrocardiogram Criteria for Left Ventricular Hypertrophy in Korean Cohort (Atherosclerosis Risk of a Rural Area Korean General Population)

2

조회

0

다운로드

3

인용

0

참고문헌

키워드

초록

Background: Left ventricular hypertrophy (LVH) offers prognostic information beyond that provided by the evaluation oftraditional cardiovascular risk factors. However, the validation of electrocardiogram (ECG) criteria for the diagnosis of LVH islimited in Korea general population. The purpose of this study is to investigate the diagnostic accuracy of ECG criteria for thedetection of LVH in general population. Methods: In the present study, we investigated a total of 1,946 adults from thecommunity-based cohort. The left ventricular mass index (LVMI) was estimated with echocardiographic measurement andadjusted with body surface area. LVH was defined as a value greater than or equal to the sex-specific 90th percentile value ofLVMI. ECG criteria for the diagnosis of LVH were Sokolow-Lyon criteria and Cornell criteria. Results: The LVMI wassignificantly higher in male subjects (91.1 ± 23.9 g/m2 vs. 83.9 ± 21.7 g/m2, p <0.001). The cutoff values were 120.8 g/m2 in malesubjects and 112.2 g/m2 in female subjects. The sensitivity and specificity of Sokolow-Lyon criteria were 5.6% and 93.6% in male,4.1% and 97.8% in female. Those of Cornell criteria were 2.8% and 98.7% in male, 14.3% and 95.8% in female. In male, the areaunder the receiver operating characteristic curves of Sokolow-Lyon voltage and Cornell voltage were 0.55 and 0.52. And those infemale were 0.59 and 0.60. Conclusions: In our community-based sample, ECG criteria showed low sensitivity and high specificity. The performance of ECG criteria for detection of LVH was suboptimal, suggesting limited usefulness of ECG as mass screening tools.

Abstract

Background: Left ventricular hypertrophy (LVH) offers prognostic information beyond that provided by the evaluation oftraditional cardiovascular risk factors. However, the validation of electrocardiogram (ECG) criteria for the diagnosis of LVH islimited in Korea general population. The purpose of this study is to investigate the diagnostic accuracy of ECG criteria for thedetection of LVH in general population. Methods: In the present study, we investigated a total of 1,946 adults from thecommunity-based cohort. The left ventricular mass index (LVMI) was estimated with echocardiographic measurement andadjusted with body surface area. LVH was defined as a value greater than or equal to the sex-specific 90th percentile value ofLVMI. ECG criteria for the diagnosis of LVH were Sokolow-Lyon criteria and Cornell criteria. Results: The LVMI wassignificantly higher in male subjects (91.1 ± 23.9 g/m2 vs. 83.9 ± 21.7 g/m2, p <0.001). The cutoff values were 120.8 g/m2 in malesubjects and 112.2 g/m2 in female subjects. The sensitivity and specificity of Sokolow-Lyon criteria were 5.6% and 93.6% in male,4.1% and 97.8% in female. Those of Cornell criteria were 2.8% and 98.7% in male, 14.3% and 95.8% in female. In male, the areaunder the receiver operating characteristic curves of Sokolow-Lyon voltage and Cornell voltage were 0.55 and 0.52. And those infemale were 0.59 and 0.60. Conclusions: In our community-based sample, ECG criteria showed low sensitivity and high specificity. The performance of ECG criteria for detection of LVH was suboptimal, suggesting limited usefulness of ECG as mass screening tools.

참고문헌 (25)

  1. Kannel WB, "Left ventricular hypertrophy by electrocardiogram : prevalence, incidence, and mortality in the Framingham study", Ann Intern Med, 71, pp.89~105 (1969)
  2. Kannel WB, "Electrocardiographic left ventricular hypertrophy and risk of coronary heart disease : the Framingham study", Ann Intern Med, 72, pp.813~822 (1970)
  3. Sundstrom J, "Echocardiographic and electrocardiographic diagnoses of left ventricular hypertrophy predict mortality independently of each other in a population of elderly men", Circulation, 103, pp.2346~2351 (2001)
  4. 김혜미, "여성 고혈압 환자에서 부적절한 좌심실비대와 Framingham Risk Score 및 혈관경직도와의 관계", Clinical Hypertension, 19(3), pp.81~89 (2013), 대한고혈압학회
  5. Sever PS, "Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm(ASCOT-LLA) : a multicentre randomised controlled trial", Lancet, 361, pp.1149~1158 (2003)
  6. Woythaler JN, "Accuracy of echocardiography versus electrocardiography in detecting left ventricular hypertrophy : comparison with postmortem mass measurements", J Am Coll Cardiol, 2, pp.305~311 (1983)
  7. Pewsner D, "Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension : systematic review", BMJ, 335, pp.711~ (2007)
  8. 박성미, "좌심실 질량을 이용한 새로운 한국인좌심실 비대 기준에 대한 연구", Korean Circulation Journal, 34(8), pp.775~783 (2004), 대한심장학회
  9. Schiller NB, "American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms", J Am Soc Echocardiogr, 2, pp.358~367 (1989)
  10. Devereux RB, "Standardization of M-mode echocardiographic left ventricular anatomic measurements", J Am Coll Cardiol, 4, pp.1222~1230 (1984)
  11. Vasan RS, "Plasma natriuretic peptides for community screening for left ventricular hypertrophy and systolic dysfunction : the Framingham heart study", JAMA, 288, pp.1252~1259 (2002)
  12. Sokolow M, "The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads", Am Heart J, 37, pp.161~186 (1949)
  13. Casale PN, "Electrocardiographic detection of left ventricular hypertrophy : development and prospective validation of improved criteria", J Am Coll Cardiol, 6, pp.572~580 (1985)
  14. Levy D, "Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study", N Engl J Med, 322, pp.1561~1566 (1990)
  15. Kim TS, "From hypertension to heart failure", Korean Hypertension J, 15, pp.1~11 (2009)
  16. Kannel WB, "Prevalence and natural history of electrocardiographic left ventricular hypertrophy", Am J Med, 75, pp.4~11 (1983)
  17. Wong CY, "Alterations of left ventricular myocardial characteristics associated with obesity", Circulation, 110, pp.3081~3087 (2004)
  18. Hinderliter AL, "Racial differences in left ventricular structure in healthy young adults", Am J Cardiol, 69, pp.1196~1199 (1992)
  19. Harshfield GA, "Racial differences in the age-related increase in left ventricular mass in youths", Hypertension, 24, pp.747~751 (1994)
  20. Daimon M, "Normal values of echocardiographic parameters in relation to age in a healthy Japanese population : the JAMP study", Circ J, 72, pp.1859~1866 (2008)
  21. Park SW, "Multicenter trial for estimation of normal values of echocardiographic indices in Korea", Korean Circ J, 30, pp.373~382 (2000)
  22. Chobanian AV, "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure : the JNC 7 report", JAMA, 289, pp.2560~2572 (2003)
  23. 박진규, "A Comparison of Cornell and Sokolow-Lyon Electrocardiographic Criteria for Left Ventricular Hypertrophy in Korean Patients", Korean Circulation Journal, 42(9), pp.606~613 (2012), 대한심장학회
  24. Alfakih K, "New gender-specific partition values for ECG criteria of left ventricular hypertrophy : recalibration against cardiac MRI", Hypertension, 44, pp.175~179 (2004)
  25. Okin PM, "Baseline characteristics in relation to electrocardiographic left ventricular hypertrophy in hypertensive patients: the Losartan intervention for endpoint reduction (LIFE) in hypertension study. The Life Study Investigators", Hypertension, 36, pp.766~773 (2000)

이 간행물의 다른 논문 (2건)