The value of the electrocardiogram SV3+RV5/V6 criteria in the diagnosis of left ventricular hypertrophy in marathon runners
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摘要: 目的 测试心电图SV3+RV5/V6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SV3+RV5/V6标准与马拉松跑者LVH的相关性，并与Cornell标准(SV3+RaVL)、改良Cornell标准(SD+RaVL)、Sokolow-Lyon标准(SV1+RV5/V6)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SV3+RV5/V6、SV1+RV5/V6、SV3+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SV3+RV5/V6及SV3+RaVL在LVH组增高，均差异有统计学意义(均P < 0.05)。ROC分析显示，SV3+RV5/V6标准的曲线下面积(AUC)大于SV3+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SV3+RV5/V6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SV3+RV5/V6标准与马拉松跑者LVH相关。
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关键词:
- 左心室肥厚 /
- 马拉松跑者 /
- 心电图 /
- SV3+RV5/V6标准
Abstract: Objective To assess the value of electrocardiogram(ECG) SV3+RV5/V6criteria 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 SV3+RV5/V6 criteria and LVH in marathon runners was analysed using multiple linear regression stratified by sex and compared with the Cornell(SV3+RaVL), modified Cornell(SD+RaVL), Sokolow-Lyon(SV1+RV5/V6) 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 SV3+RV5/V6, SV1+RV5/V6, SV3+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 SV3+RV5/V6 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 SV3+RV5/V6 criteria was higher than that of SV3+RaVL criteria(0.879 vs 0.800, P < 0.05). Additionally, curve fitting showed that the ECG SV3+RV5/V6 values increased with increasing LVMI in marathon runners, exhibiting a nearly linear positive correlation.Conclusion The ECG SV3+RV5/V6 criteria is correlated with LVH in marathon runners.-
Key words:
- left ventricular hypertrophy /
- Marathon runners /
- electrocardiogram /
- SV3+RV5/V6 criteria
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图 1 SV3+RV5/V6和SV3+RaVL诊断马拉松跑者LVH的ROC曲线
Figure 1. ROC curves of SV3+RV5/V6 and SV3+RaVL in diagnosing LVH in marathon runners
表 1 所有受试者一般临床特征及心电图、超声心动图资料
Table 1. General clinical characteristics and electrocardiogram, echocardiography indicators
例(%), X±S 项目 LVMI正常组(96例) LVH组(16例) P值 男性 59(61.46) 10(62.50) 0.937 年龄/岁 45.74±7.21 49.31±8.12 0.174 BSA/m2 1.71±0.17 1.68±0.14 0.503 BMI/(kg/m2) 22.83±2.47 23.38±1.51 0.389 收缩压/mmHg 131.89±15.87 138.09±16.78 0.148 舒张压/mmHg 80.39±10.19 85.38±12.65 0.132 抽烟史 15(15.63) 3(18.75) 0.555 饮酒史 24(25.00) 4(25.00) 0.660 高血压史 10(10.42) 3(18.75) 0.329 糖尿病史 1(1.04) 1(6.25) 0.266 猝死家族史 2(2.08) 0 0.564 LVEF/% 64.71±2.16 63.69±3.55 0.117 男性LVMI/(g/m2) 89.08±12.74 127.75±8.42 < 0.001 女性LVMI/(g/m2) 80.00±9.82 107.88±11.68 < 0.001 SV3+RV5/V6/mV 2.65±0.96 4.06±0.86 < 0.001 SD+SV4/mV 2.01±1.01 2.57±1.11 0.043 SV1+RV5/V6/mV 2.55±0.86 3.32±1.10 0.002 SV3+RaVL/mV 1.15±0.62 1.82±0.57 < 0.001 SD+RaVL/mV 1.63±0.62 1.99±0.58 0.034 马拉松跑龄 0.646 跑龄 < 1年 7(7.29) 0 1年≤跑龄 < 3年 37(38.54) 6(37.50) 3≤跑龄 < 6年 35(36.45) 8(50.00) 跑龄≥6年 17(17.70) 2(12.50) 平时月跑量 0.196 月跑量 < 60 km 10(10.42) 1(6.25) 60 km≤月跑量 < 100 km 17(17.71) 0 100 km≤月跑量 < 200 km 36(37.50) 8(50.00) 200 km≤月跑量 < 300 km 29(30.21) 6(37.50) ≥300 km 4(4.17) 1(6.250) 半程马拉松赛次数 16.26±22.35 11.81±12.10 0.440 半程马拉松赛最好成绩/min 110.06±23.89 108.27±10.92 0.786 全程马拉松赛次数 4.05±6.35 2.06±3.26 0.224 全程马拉松赛最好成绩/min 236.08±34.83 257.69±46.20 0.165 
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表 2 男性马拉松跑者心电图指标的线性回归分析结果
Table 2. Linear regression analysis results of electrocardiogram indicators in male marathon runners
项目 模型1(无校正) 模型2(按年龄、BMI、高血压史校正) B 95%CI P值 B 95%CI P值 SV3+RV5/V6 0.002 LVMI正常组 参考 参考 LVH组 1.315 0.709~1.921 < 0.001 1.02 0.390~1.650 SD+RaVL 0.17 LVMI正常组 参考 参考 LVH组 0.466 0.045~0.886 0.031 0.294 -0.129~0.718 SD+SV4 0.303 LVMI正常组 参考 参考 LVH组 0.716 -0.016~1.448 0.055 0.381 -0.353~1.115 SV3+RaVL 0.013 LVMI正常组 参考 参考 LVH组 0.648 0.231~1.064 0.003 0.566 0.122~1.010 SV1+RV5/V6 0.028 LVMI正常组 参考 参考 LVH组 1.067 0.486~1.649 < 0.001 0.668 0.076~1.261
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表 3 女性马拉松跑者心电图指标的线性回归分析结果
Table 3. Linear regression analysis results of electrocardiogram indicators in female marathon runners
项目 模型1(无校正) 模型2(按年龄、BMI、高血压史校正) B 95%CI P值 B 95%CI P值 SV3+RV5/V6 < 0.001 LVMI正常组 参考 参考 LVH组 1.529 1.096~1.962 < 0.001 1.598 1.134~2.062 SD+RaVL 0.346 LVMI正常组 参考 参考 LVH组 0.162 -0.204~0.528 0.377 0.179 -0.200~0.557 SD+SV4 0.147 LVMI正常组 参考 参考 LVH组 0.293 -0.191~0.776 0.228 0.373 -0.137~0.882 SV3+RaVL < 0.001 LVMI正常组 参考 参考 LVH组 0.687 0.377~0.997 < 0.001 0.679 0.350~ 1.008 SV1+RV5/V6 0.357 LVMI正常组 参考 参考 LVH组 0.235 -0.380~0.850 0.444 0.305 -0.357, 0.966
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表 4 SV3+RV5/V6和SV3+RaVL诊断马拉松跑者LVH的效能
Table 4. The efficiency of SV3+RV5/V6 and SV3+RaVL in diagnosing LVH in marathon runners
指标 AUC 截断值/mV 特异度/% 灵敏度/% 约登指数 SV3+RV5/V6 0.879 3.21 77.08 93.75 0.71 SV3+RaVL 0.800 1.05 52.14 99.94 0.52
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表 5 SV3+RV5/V6诊断不同性别马拉松跑者LVH的效能
Table 5. The efficacy of SV3+RV5/V6 in diagnosing LVH in marathon runners with different genders
性别 截断值/mV 特异度/% 灵敏度/% 约登指数 男性 3.71 83.05 90.00 0.73 女性 2.74 97.30 100.00 0.97
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