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Kokyu to Junkan Volume 48, Issue 2 （February 2000）

呼吸と循環 48巻2号（2000年2月発行）

Japanese English

研究

高血圧性心肥大による心不全—心電図所見の特徴と心エコーによる左室心筋重量係数 Congestive Heart Failure due to Hypertensive Left Ventricular Hypertrophy:Electrocardiographic features and left ventricular mass index by echocardiography 高橋俊明 ¹ , 伏見悦子 ¹ , 関口展代 ¹ , 渡辺一 ¹ , 林雅人 ¹ Toshiaki Takahashi ¹ , Etsuko Fushimi ¹ , Nobuyo Sekiguchi ¹ , Hajime Watanabe ¹ , Masato Hayashi ¹ ¹平鹿総合病院第二内科 ¹The Second Department of Internal Medicine, Hiraka General Hospital キーワード：高血圧性心肥大 , 心不全 , 心電図左室肥大基準 , 左室心筋重量係数 , hypertensive left ventricular hypertrophy , heart failuer , ECG criteria of left ventricular hypertrophy , left ventricular mass index Keyword: 高血圧性心肥大 , 心不全 , 心電図左室肥大基準 , 左室心筋重量係数 , hypertensive left ventricular hypertrophy , heart failuer , ECG criteria of left ventricular hypertrophy , left ventricular mass index pp.181-186

発行日 2000年2月15日 Published Date 2000/2/15

DOI https://doi.org/10.11477/mf.1404902046

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Abstract 文献概要
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　高血圧性心不全の心電図所見の特徴を明らかにし，心不全に至る左室心筋重量係数（LVM／m²）を推定するため以下の検討を行った．高血圧性心不全で入院し，安定期に精査を行った男性17例（A群：69歳以下；n＝6,B群：70歳以上；n＝11）と，心不全のない高血圧例の対照（C群：69歳以下：n＝8）の合計25例において，心電図所見（Romhilt-Estesポイントスコアシステム：R-E,Sokolow-Lyon電位：S-L,Cornell電位）と心エコーから求めたLVM／m²，心臓カテーテル検査の所見とを比較検討した．心電図では全体の26％（Cornell電位）〜65％（R-E），心エコーでは88％が左室肥大と判定された．この集団の中で以下のことが結論された．1）胸部誘導の電位差よりも，QRS時間（r＝0.59），R-Eのスコア（r＝0.61）がLVM／m²と良好な相関を示した．2）高血圧性心肥大ではLVM／m²≧180gになると心不全の危険性が高くなる．

To define the characteristic features of electrocardio-graphy in hypertensives with heart failure, we comparedelectrocardiographic findings using the following criter-ia; Romhilt-Estes point score system (R-E), Sokolow-Lyon voltage criteria (S-L), Cornell voltage criteria(Cornell), with echocardiographically determined leftventricular mass index (LVM/m²) and cardiac catheter-ization measurements in 17 hypertensive men with apast history of heart failure (group A;≦69y: n=6,group B;≧70y :n=11) and hypertensive men with-out heart failure (group C;≦69y:n=8).

The incidence of left ventricular hypertrophy was26% (Cornell) to 65% (R-E) by electrocardiographyand 88% by echocardiography among all subjects.Although LVM/m² were similar in both group A andB, the R-E score and S-L voltage were significantlygreater for group A than for B. S-L voltages were quitesimilar for both group B and C.

Electrocardiographic validation of these criteria forheart failure revealed superior sensitivity in R-E volt-age, ST-T change, QRS duration≧0.09sec, R-E score,and S-L voltage, and superior specificity in left axisdeviation, QRS duration≧0.09sec, VAT≧0.05sec, andCornell voltage. LVM/m² correlated well with QRSduration (r=0.59) and R-E score (r=0.61), but did not correlated well with S-L voltage.

Setting the cut-off point of LVM/m² for failed heartfrom non-failed heart seemed appropriate at 180g,which achieved a sensitivity of 70%, specificity of 88%,positive predictive value of 92%, negative predictivevalue of 58%, and overall accuracy of 76% in hyperten-sive left ventricular hypertrophy.

It is concluded that 1) LVM/m² had little correlationwith the voltages of the precordial leads, but had asignificant correlations with QRS duration (r=0.59) andR-E score (r=0.61). 2) The critical value of LVM/m²for hypertensive heart failure was 180g.