Intravital and postmortem diagnostics of myocardial hypertrophy of the left ventricle:identity or convention?


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Abstract

The aim of the study is to assess the compliance of the results of electrocardiographic (ECG) and echocardiographic diagnostic methods of hypertrophy of left ventricular myocardium (LVH) with the postmortem finding of measurement of left ventricular myocardium mass (LVM). Materials and methods. We examined the data of intravital study of anthropometric measurements [age, height, weight, body mass index (BMI)], instrumental results [12-lead ECG, EchoCG], as well as the postmortem finding (direct measurement of LVM at autopsy) in 15 patients of general therapy department. While analyzing ECG we studied as conventional ECG criteria for the detection of LVH as well as the author's own criteria based on two models (regression and discriminant analyses), including voltage, sex and age criteria. Echocardiographic diagnostic method used to calculate LVM (according to ASE formula) and left ventricular mass index (LVMI). Postmortem finding of LVM was carried out according to the standard measurement method. According to the absence of the single conventional postmortem finding of measurement of LVH, we considered three different variants of the postmortem finding of LVH: the criterion of K. Bove et al. (CB); the criterion of A.M. Lifshitz, also called ventricular index (VI) and the criterion of P. Casale - the left ventricular mass index at autopsy (LVMI). Results and discussion. Conventional ECG criteria for the detection of LVH showed high specificity (71-100%) using any method of the postmortem finding of measurement, but were characterized by extremely low sensitivity (0-37.5%). Their overall diagnostic accuracy was higher on using K. Bove or A.M. Lifshitz criteria (40-66.7%) and low - on using the criterion of P. Casale (13.3-40%). The author's ECG criteria were less specificity (50-100%) and had higher sensitivity (54-75%), and their diagnostic accuracy remained higher and showed small dependence on the method of the postmortem finding of measurement of LVH (60-66.7%). Conclusion. Usually the ECG criteria to diagnose left ventricular hypertrophy were expectedly showed low sensitivity using any method of the postmortem finding of measurement. Meanwhile, the author's own ECG criteria associated with the most sensitive electrocardiographic characteristics to LVH and sex and age-specific indexes of the examined patients exceeded the conventional ECG criteria in sensitivity and diagnostic accuracy.

About the authors

S N Bogomolov

Military Medical Academy

Email: pashalesha@yandex.ru
ассистент каф. пропедевтики внутренних болезней St. Petersburg, Russia

A N Kulikov

Military Medical Academy; Pavlov Medical University

Email: ankulikov2005@yandex.ru
д.м.н., проф. каф. пропедевтики внутренних болезней ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» МО РФ; зам. главного врача по медицинской части (по терапии), руководитель отдела клинической физиологии и функциональной диагностики ФГБОУ ВО «ПСПбГМУ им. акад. И.П. Павлова» МЗ РФ St. Petersburg, Russia

J A Tikhonova

Pavlov Medical University

Email: jat1@mail.ru
к.м.н., доцент каф. патологической анатомии с патологоанатомическим отд-нием St. Petersburg, Russia

V N Solntsev

Almazov Federal Medical Research Centre

Email: vs5962@gmail.com
с.н.с. НИЛ биостатистики НИО математического моделирования и анализа St. Petersburg, Russia

M G Rybakova

Pavlov Medical University

Email: rybakova@spb-gmu.ru
д.м.н., проф., зав. каф. патологической анатомии с патологоанатомическим отд-нием St. Petersburg, Russia

A Y Gudkova

Pavlov Medical University; Almazov Federal Medical Research Centre

Email: alexagood-1954@mail.ru
д.м.н., зав. лаб. кардиомиопатий Института сердечно-сосудистых заболеваний, проф. каф. факультетской терапии ФГБОУ ВПО «ПСПбГМУ им. акад. И.П. Павлова»; в.н.с. Института молекулярной биологии и генетики ФГБУ «НМИЦ им. В.А. Алмазова» St. Petersburg, Russia

A N Kuchmin

Military Medical Academy

Email: kuchmin.63@mail.ru
д.м.н., проф., зав. каф. пропедевтики внутренних болезней St. Petersburg, Russia

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