Validity of electrocardiographic criteria for increased left ventricular mass in young patients in the general population
|
摘要
AIMTo investigate validity of electrocardiographic(ECG)criteria for left ventricular hypertrophy(LVH)in young adults.METHODS Retrospectively,echocardiograms showing LVH and concomitant electrocardiograms were collected in patients 18 to 39 years old.A control group of patients without LVH was collected.Using echocardiogram as the gold standard,electrocardiograms were analyzed using common voltage criteria.RESULTS Study included 100 subjects(52%male,mean age=28±6.8 years,96%Hispanic or African-American)with 50%LVH prevalence.Sensitivity and specificity for SokolowLyon criteria were 24%(95%CI:13.5%-38.4%)and 88%(95%CI:74.9%-95%).For Cornell criteria,sensitivity was 32%(95%CI:19.9%-46.8%)and specificity 98%(95%CI:87.9%-99.8%).For R in a VL criteria,sensitivity was 12%(95%CI:4.9%-25%)and specificity 100%(95%CI:91.1%-100%).CONCLUSION In young adults common ECG voltage criteria have low sensitivities and high specificities similar to other age groups.Low sensitivities preclude these ECG criteria from serving as effective screening tests.
AIMTo investigate validity of electrocardiographic(ECG)criteria for left ventricular hypertrophy(LVH)in young adults.METHODS Retrospectively,echocardiograms showing LVH and concomitant electrocardiograms were collected in patients 18 to 39 years old.A control group of patients without LVH was collected.Using echocardiogram as the gold standard,electrocardiograms were analyzed using common voltage criteria.RESULTS Study included 100 subjects(52%male,mean age=28±6.8 years,96%Hispanic or African-American)with 50%LVH prevalence.Sensitivity and specificity for SokolowLyon criteria were 24%(95%CI:13.5%-38.4%)and 88%(95%CI:74.9%-95%).For Cornell criteria,sensitivity was 32%(95%CI:19.9%-46.8%)and specificity 98%(95%CI:87.9%-99.8%).For R in a VL criteria,sensitivity was 12%(95%CI:4.9%-25%)and specificity 100%(95%CI:91.1%-100%).CONCLUSION In young adults common ECG voltage criteria have low sensitivities and high specificities similar to other age groups.Low sensitivities preclude these ECG criteria from serving as effective screening tests.
AIMTo investigate validity of electrocardiographic(ECG)criteria for left ventricular hypertrophy(LVH)in young adults.METHODS Retrospectively,echocardiograms showing LVH and concomitant electrocardiograms were collected in patients 18 to 39 years old.A control group of patients without LVH was collected.Using echocardiogram as the gold standard,electrocardiograms were analyzed using common voltage criteria.RESULTS Study included 100 subjects(52%male,mean age=28±6.8 years,96%Hispanic or African-American)with 50%LVH prevalence.Sensitivity and specificity for SokolowLyon criteria were 24%(95%CI:13.5%-38.4%)and 88%(95%CI:74.9%-95%).For Cornell criteria,sensitivity was 32%(95%CI:19.9%-46.8%)and specificity 98%(95%CI:87.9%-99.8%).For R in a VL criteria,sensitivity was 12%(95%CI:4.9%-25%)and specificity 100%(95%CI:91.1%-100%).CONCLUSION In young adults common ECG voltage criteria have low sensitivities and high specificities similar to other age groups.Low sensitivities preclude these ECG criteria from serving as effective screening tests.
引文
1 Ghali JK,Liao Y,Simmons B,Castaner A,Cao G,Cooper RS.The prognostic role of left ventricular hypertrophy in patients with or without coronary artery disease.Ann Intern Med 1992;117:831-836[PMID:1416558 DOI:10.7326/0003-4819-117-10-831]
2 Koren MJ,Devereux RB,Casale PN,Savage DD,Laragh JH.Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension.Ann Intern Med1991;114:345-352[PMID:1825164 DOI:10.7326/0003-4819-114-5-345]
3 Levy D,Garrison RJ,Savage DD,Kannel WB,Castelli WP.Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study.N Engl J Med 1990;322:1561-1566[PMID:2139921 DOI:10.1056/NEJM199005313222203]
4 Wachtell K,Palmieri V,Gerdts E,Bella JN,Aurigemma GP,Papademetriou V,Dahl?f B,Aalto T,Ibsen H,Rokkedal JE,Devereux RB.Prognostic significance of left ventricular diastolic dysfunction in patients with left ventricular hypertrophy and systemic hypertension(the LIFE Study).Am J Cardiol 2010;106:999-1005[PMID:20854964 DOI:10.1016/j.amjcard.2010.05.032]
5 Levy D,Savage DD,Garrison RJ,Anderson KM,Kannel WB,Castelli WP.Echocardiographic criteria for left ventricular hypertrophy:the Framingham Heart Study.Am J Cardiol 1987;59:956-960[PMID:2952002 DOI:10.1016/0002-9149(87)91133-7]
6 Bella JN,Devereux RB,Roman MJ,O’Grady MJ,Welty TK,Lee ET,Fabsitz RR,Howard BV.Relations of left ventricular mass to fat-free and adipose body mass:the strong heart study.The Strong Heart Study Investigators.Circulation 1998;98:2538-2544[PMID:9843460 DOI:10.1161/01.CIR.98.23.2538]
7 Savage DD,Drayer JI,Henry WL,Mathews EC,Ware JH,Gardin JM,Cohen ER,Epstein SE,Laragh JH.Echocardiographic assessment of cardiac anatomy and function in hypertensive subjects.Circulation 1979;59:623-632[PMID:421302 DOI:10.1161/01.CIR.59.4.623]
8 Kaplan NM,Lieberman E,Neal W.Kaplan’s clinical hypertension.8th ed.Philadelphia:Lippincott,Williams&Wilkins,2002
9 Hammond IW,Devereux RB,Alderman MH,Lutas EM,Spitzer MC,Crowley JS,Laragh JH.The prevalence and correlates of echocardiographic left ventricular hypertrophy among employed patients with uncomplicated hypertension.J Am Coll Cardiol 1986;7:639-650[PMID:2936789 DOI:10.1016/S0735-1097(86)80476-4]
10 Movahed MR,Bates S,Strootman D,Sattur S.Obesity in adolescence is associated with left ventricular hypertrophy and hypertension.Echocardiography 2011;28:150-153[PMID:21276070 DOI:10.1111/j.1540-8175.2010.01289.x]
11 Cuspidi C,Meani S,Sala C,Valerio C,Negri F,Mancia G.Age related prevalence of severe left ventricular hypertrophy in essential hypertension:echocardiographic findings from the ETODH study.Blood Press 2012;21:139-145[PMID:22416806 DOI:10.3109/08037051.2012.668662]
12 Corrado D,Drezner J,Basso C,Pelliccia A,Thiene G.Strategies for the prevention of sudden cardiac death during sports.Eur JCardiovasc Prev Rehabil 2011;18:197-208[PMID:21567995DOI:10.1177/1741826710389924]
13 Hill AC,Miyake CY,Grady S,Dubin AM.Accuracy of interpretation of preparticipation screening electrocardiograms.J Pediatr 2011;159:783-788[PMID:21752393 DOI:10.1016/j.jpeds.2011.05.014]
14 SOKOLOW M,LYON TP.The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads.Am Heart J 1949;37:161-186[PMID:18107386 DOI:10.1016/0002-8703(49)90562-1]
15 Casale PN,Devereux RB,Kligfield P,Eisenberg RR,Miller DH,Chaudhary BS,Phillips MC.Electrocardiographic detection of left ventricular hypertrophy:development and prospective validation of improved criteria.J Am Coll Cardiol 1985;6:572-580[PMID:3161926 DOI:10.1016/S0735-1097(85)80115-7]
16 Lang RM,Bierig M,Devereux RB,Flachskampf FA,Foster E,Pellikka PA,Picard MH,Roman MJ,Seward J,Shanewise JS,Solomon SD,Spencer KT,Sutton MS,Stewart WJ.Recommendations for chamber quantification:a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group,developed in conjunction with the European Association of Echocardiography,a branch of the European Society of Cardiology.J Am Soc Echocardiogr 2005;18:1440-1463[PMID:16376782 DOI:10.1016/j.echo.2005.10.005]
17 Molloy TJ,Okin PM,Devereux RB,Kligfield P.Electrocardiographic detection of left ventricular hypertrophy by the simple QRS voltageduration product.J Am Coll Cardiol 1992;20:1180-1186[PMID:1401620 DOI:10.1016/0735-1097(92)90376-X]
18 Gubner R UH.Electrocardiographic criteria of left ventricular hypertrophy.Arch Intern Med 1943;(72):196-206[DOI:10.1001/archinte.1943.00210080052005]
19 Devereux RB,Bella J,Boman K,Gerdts E,Nieminen MS,Rokkedal J,Papademetriou V,Wachtell K,Wright J,Paranicas M,Okin PM,Roman MJ,Smith G,Dahl?f B.Echocardiographic left ventricular geometry in hypertensive patients with electrocardiographic left ventricular hypertrophy:The LIFE Study.Blood Press 2001;10:74-82[PMID:11467763 DOI:10.1080/08037050152112050]
20 Okin PM,Devereux RB,Jern S,Kjeldsen SE,Julius S,Nieminen MS,Snapinn S,Harris KE,Aurup P,Edelman JM,Wedel H,Lindholm LH,Dahl?f B.Regression of electrocardiographic left ventricular hypertrophy during antihypertensive treatment and the prediction of major cardiovascular events.JAMA 2004;292:2343-2349[PMID:15547161 DOI:10.1001/jama.292.19.2343]
21 Pewsner D,Jüni P,Egger M,Battaglia M,Sundstr?m J,Bachmann LM.Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension:systematic review.BMJ 2007;335:711[PMID:17726091 DOI:10.1136/bmj.39276.636354.AE]
22 Crow RS,Prineas RJ,Rautaharju P,Hannan P,Liebson PR.Relation between electrocardiography and echocardiography for left ventricular mass in mild systemic hypertension(results from Treatment of Mild Hypertension Study).Am J Cardiol 1995;75:1233-1238[PMID:7778546 DOI:10.1016/S0002-9149(99)80769-3]
23 Dada A,Adebiyi AA,Aje A,Oladapo OO,Falase AO.Standard electrocardiographic criteria for left ventricular hypertrophy in Nigerian hypertensives.Ethn Dis 2005;15:578-584[PMID:16259479]
24 Vottonen P,Husso M,Sipola P,Vanninen R,Peuhkurinen K,Magga J.Electrocardiographic left ventricular hypertrophy has low diagnostic accuracy in middle-aged subjects.Blood Press 2007;16:328-334[PMID:17852087 DOI:10.1080/08037050701288255]
25 Casiglia E,Schiavon L,Tikhonoff V,Bascelli A,Martini B,Mazza A,Caffi S,D’Este D,Bagato F,Bolzon M,Guidotti F,Haxhi Nasto H,Saugo M,Guglielmi F,Pessina AC.Electrocardiographic criteria of left ventricular hypertrophy in general population.Eur J Epidemiol 2008;23:261-271[PMID:18322806 DOI:10.1007/s10654-008-9234-6]
26 Casale PN,Devereux RB,Alonso DR,Campo E,Kligfield P.Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms:validation with autopsy findings.Circulation 1987;75:565-572[PMID:2949887 DOI:10.1161/01.CIR.75.3.565]
27 Rijnbeek PR,van Herpen G,Kapusta L,Ten Harkel AD,Witsenburg M,Kors JA.Electrocardiographic criteria for left ventricular hypertrophy in children.Pediatr Cardiol 2008;29:923-928[PMID:18437446 DOI:10.1007/s00246-008-9235-y]
28 Grossman A,Prokupetz A,Koren-Morag N,Grossman E,Shamiss A.Comparison of usefulness of Sokolow and Cornell criteria for left ventricular hypertrophy in subjects aged<20 years versus>30 years.Am J Cardiol 2012;110:440-444[PMID:22534054DOI:10.1016/j.amjcard.2012.03.047]
29 Sohaib SM,Payne JR,Shukla R,World M,Pennell DJ,Montgomery HE.Electrocardiographic(ECG)criteria for determining left ventricular mass in young healthy men;data from the LARGE Heart study.J Cardiovasc Magn Reson 2009;11:2[PMID:19149884 DOI:10.1186/1532-429X-11-2]
30 Rawlins J,Carre F,Kervio G,Papadakis M,Chandra N,Edwards C,Whyte GP,Sharma S.Ethnic differences in physiological cardiac adaptation to intense physical exercise in highly trained female athletes.Circulation 2010;121:1078-1085[PMID:20176985 DOI:10.1161/CIRCULATIONAHA.109.917211]
31 Somauroo JD,Pyatt JR,Jackson M,Perry RA,Ramsdale DR.An echocardiographic assessment of cardiac morphology and common ECG findings in teenage professional soccer players:reference ranges for use in screening.Heart 2001;85:649-654[PMID:11359746 DOI:10.1136/heart.85.6.649]
32 Di Bella MA,Carbone MC,De Leo G.Aspects of cell production in mantle tissue of Ciona intestinalis L.(Tunicata,Ascidiacea).Micron 2005;36:477-481[PMID:15935306 DOI:10.3109/9780203503249-33]
33 Wachtell K,Bella JN,Rokkedal J,Palmieri V,Papademetriou V,Dahl?f B,Aalto T,Gerdts E,Devereux RB.Change in diastolic left ventricular filling after one year of antihypertensive treatment:The Losartan Intervention For Endpoint Reduction in Hypertension(LIFE)Study.Circulation 2002;105:1071-1076[PMID:11877357DOI:10.1161/hc0902.104599]
34 Solomon SD,Verma A,Desai A,Hassanein A,Izzo J,Oparil S,Lacourciere Y,Lee J,Seifu Y,Hilkert RJ,Rocha R,Pitt B.Effect of intensive versus standard blood pressure lowering on diastolic function in patients with uncontrolled hypertension and diastolic dysfunction.Hypertension 2010;55:241-248[PMID:19996069DOI:10.1161/HYPERTENSIONAHA.109.138529]
35 Maron BJ,Thompson PD,Ackerman MJ,Balady G,Berger S,Cohen D,Dimeff R,Douglas PS,Glover DW,Hutter AM,Krauss MD,Maron MS,Mitten MJ,Roberts WO,Puffer JC.Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes:2007 update:a scientific statement from the American Heart Association Council on Nutrition,Physical Activity,and Metabolism:endorsed by the American College of Cardiology Foundation.Circulation 2007;115:1643-1455[PMID:17353433DOI:10.1161/CIRCULATIONAHA.107.181423]
36 Weiner RB,Hutter AM,Wang F,Kim JH,Wood MJ,Wang TJ,Picard MH,Baggish AL.Performance of the 2010 European Society of Cardiology criteria for ECG interpretation in athletes.Heart 2011;97:1573-1577[PMID:21602522 DOI:10.1136/hrt.2011.227330]
2 Koren MJ,Devereux RB,Casale PN,Savage DD,Laragh JH.Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension.Ann Intern Med1991;114:345-352[PMID:1825164 DOI:10.7326/0003-4819-114-5-345]
3 Levy D,Garrison RJ,Savage DD,Kannel WB,Castelli WP.Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study.N Engl J Med 1990;322:1561-1566[PMID:2139921 DOI:10.1056/NEJM199005313222203]
4 Wachtell K,Palmieri V,Gerdts E,Bella JN,Aurigemma GP,Papademetriou V,Dahl?f B,Aalto T,Ibsen H,Rokkedal JE,Devereux RB.Prognostic significance of left ventricular diastolic dysfunction in patients with left ventricular hypertrophy and systemic hypertension(the LIFE Study).Am J Cardiol 2010;106:999-1005[PMID:20854964 DOI:10.1016/j.amjcard.2010.05.032]
5 Levy D,Savage DD,Garrison RJ,Anderson KM,Kannel WB,Castelli WP.Echocardiographic criteria for left ventricular hypertrophy:the Framingham Heart Study.Am J Cardiol 1987;59:956-960[PMID:2952002 DOI:10.1016/0002-9149(87)91133-7]
6 Bella JN,Devereux RB,Roman MJ,O’Grady MJ,Welty TK,Lee ET,Fabsitz RR,Howard BV.Relations of left ventricular mass to fat-free and adipose body mass:the strong heart study.The Strong Heart Study Investigators.Circulation 1998;98:2538-2544[PMID:9843460 DOI:10.1161/01.CIR.98.23.2538]
7 Savage DD,Drayer JI,Henry WL,Mathews EC,Ware JH,Gardin JM,Cohen ER,Epstein SE,Laragh JH.Echocardiographic assessment of cardiac anatomy and function in hypertensive subjects.Circulation 1979;59:623-632[PMID:421302 DOI:10.1161/01.CIR.59.4.623]
8 Kaplan NM,Lieberman E,Neal W.Kaplan’s clinical hypertension.8th ed.Philadelphia:Lippincott,Williams&Wilkins,2002
9 Hammond IW,Devereux RB,Alderman MH,Lutas EM,Spitzer MC,Crowley JS,Laragh JH.The prevalence and correlates of echocardiographic left ventricular hypertrophy among employed patients with uncomplicated hypertension.J Am Coll Cardiol 1986;7:639-650[PMID:2936789 DOI:10.1016/S0735-1097(86)80476-4]
10 Movahed MR,Bates S,Strootman D,Sattur S.Obesity in adolescence is associated with left ventricular hypertrophy and hypertension.Echocardiography 2011;28:150-153[PMID:21276070 DOI:10.1111/j.1540-8175.2010.01289.x]
11 Cuspidi C,Meani S,Sala C,Valerio C,Negri F,Mancia G.Age related prevalence of severe left ventricular hypertrophy in essential hypertension:echocardiographic findings from the ETODH study.Blood Press 2012;21:139-145[PMID:22416806 DOI:10.3109/08037051.2012.668662]
12 Corrado D,Drezner J,Basso C,Pelliccia A,Thiene G.Strategies for the prevention of sudden cardiac death during sports.Eur JCardiovasc Prev Rehabil 2011;18:197-208[PMID:21567995DOI:10.1177/1741826710389924]
13 Hill AC,Miyake CY,Grady S,Dubin AM.Accuracy of interpretation of preparticipation screening electrocardiograms.J Pediatr 2011;159:783-788[PMID:21752393 DOI:10.1016/j.jpeds.2011.05.014]
14 SOKOLOW M,LYON TP.The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads.Am Heart J 1949;37:161-186[PMID:18107386 DOI:10.1016/0002-8703(49)90562-1]
15 Casale PN,Devereux RB,Kligfield P,Eisenberg RR,Miller DH,Chaudhary BS,Phillips MC.Electrocardiographic detection of left ventricular hypertrophy:development and prospective validation of improved criteria.J Am Coll Cardiol 1985;6:572-580[PMID:3161926 DOI:10.1016/S0735-1097(85)80115-7]
16 Lang RM,Bierig M,Devereux RB,Flachskampf FA,Foster E,Pellikka PA,Picard MH,Roman MJ,Seward J,Shanewise JS,Solomon SD,Spencer KT,Sutton MS,Stewart WJ.Recommendations for chamber quantification:a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group,developed in conjunction with the European Association of Echocardiography,a branch of the European Society of Cardiology.J Am Soc Echocardiogr 2005;18:1440-1463[PMID:16376782 DOI:10.1016/j.echo.2005.10.005]
17 Molloy TJ,Okin PM,Devereux RB,Kligfield P.Electrocardiographic detection of left ventricular hypertrophy by the simple QRS voltageduration product.J Am Coll Cardiol 1992;20:1180-1186[PMID:1401620 DOI:10.1016/0735-1097(92)90376-X]
18 Gubner R UH.Electrocardiographic criteria of left ventricular hypertrophy.Arch Intern Med 1943;(72):196-206[DOI:10.1001/archinte.1943.00210080052005]
19 Devereux RB,Bella J,Boman K,Gerdts E,Nieminen MS,Rokkedal J,Papademetriou V,Wachtell K,Wright J,Paranicas M,Okin PM,Roman MJ,Smith G,Dahl?f B.Echocardiographic left ventricular geometry in hypertensive patients with electrocardiographic left ventricular hypertrophy:The LIFE Study.Blood Press 2001;10:74-82[PMID:11467763 DOI:10.1080/08037050152112050]
20 Okin PM,Devereux RB,Jern S,Kjeldsen SE,Julius S,Nieminen MS,Snapinn S,Harris KE,Aurup P,Edelman JM,Wedel H,Lindholm LH,Dahl?f B.Regression of electrocardiographic left ventricular hypertrophy during antihypertensive treatment and the prediction of major cardiovascular events.JAMA 2004;292:2343-2349[PMID:15547161 DOI:10.1001/jama.292.19.2343]
21 Pewsner D,Jüni P,Egger M,Battaglia M,Sundstr?m J,Bachmann LM.Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension:systematic review.BMJ 2007;335:711[PMID:17726091 DOI:10.1136/bmj.39276.636354.AE]
22 Crow RS,Prineas RJ,Rautaharju P,Hannan P,Liebson PR.Relation between electrocardiography and echocardiography for left ventricular mass in mild systemic hypertension(results from Treatment of Mild Hypertension Study).Am J Cardiol 1995;75:1233-1238[PMID:7778546 DOI:10.1016/S0002-9149(99)80769-3]
23 Dada A,Adebiyi AA,Aje A,Oladapo OO,Falase AO.Standard electrocardiographic criteria for left ventricular hypertrophy in Nigerian hypertensives.Ethn Dis 2005;15:578-584[PMID:16259479]
24 Vottonen P,Husso M,Sipola P,Vanninen R,Peuhkurinen K,Magga J.Electrocardiographic left ventricular hypertrophy has low diagnostic accuracy in middle-aged subjects.Blood Press 2007;16:328-334[PMID:17852087 DOI:10.1080/08037050701288255]
25 Casiglia E,Schiavon L,Tikhonoff V,Bascelli A,Martini B,Mazza A,Caffi S,D’Este D,Bagato F,Bolzon M,Guidotti F,Haxhi Nasto H,Saugo M,Guglielmi F,Pessina AC.Electrocardiographic criteria of left ventricular hypertrophy in general population.Eur J Epidemiol 2008;23:261-271[PMID:18322806 DOI:10.1007/s10654-008-9234-6]
26 Casale PN,Devereux RB,Alonso DR,Campo E,Kligfield P.Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms:validation with autopsy findings.Circulation 1987;75:565-572[PMID:2949887 DOI:10.1161/01.CIR.75.3.565]
27 Rijnbeek PR,van Herpen G,Kapusta L,Ten Harkel AD,Witsenburg M,Kors JA.Electrocardiographic criteria for left ventricular hypertrophy in children.Pediatr Cardiol 2008;29:923-928[PMID:18437446 DOI:10.1007/s00246-008-9235-y]
28 Grossman A,Prokupetz A,Koren-Morag N,Grossman E,Shamiss A.Comparison of usefulness of Sokolow and Cornell criteria for left ventricular hypertrophy in subjects aged<20 years versus>30 years.Am J Cardiol 2012;110:440-444[PMID:22534054DOI:10.1016/j.amjcard.2012.03.047]
29 Sohaib SM,Payne JR,Shukla R,World M,Pennell DJ,Montgomery HE.Electrocardiographic(ECG)criteria for determining left ventricular mass in young healthy men;data from the LARGE Heart study.J Cardiovasc Magn Reson 2009;11:2[PMID:19149884 DOI:10.1186/1532-429X-11-2]
30 Rawlins J,Carre F,Kervio G,Papadakis M,Chandra N,Edwards C,Whyte GP,Sharma S.Ethnic differences in physiological cardiac adaptation to intense physical exercise in highly trained female athletes.Circulation 2010;121:1078-1085[PMID:20176985 DOI:10.1161/CIRCULATIONAHA.109.917211]
31 Somauroo JD,Pyatt JR,Jackson M,Perry RA,Ramsdale DR.An echocardiographic assessment of cardiac morphology and common ECG findings in teenage professional soccer players:reference ranges for use in screening.Heart 2001;85:649-654[PMID:11359746 DOI:10.1136/heart.85.6.649]
32 Di Bella MA,Carbone MC,De Leo G.Aspects of cell production in mantle tissue of Ciona intestinalis L.(Tunicata,Ascidiacea).Micron 2005;36:477-481[PMID:15935306 DOI:10.3109/9780203503249-33]
33 Wachtell K,Bella JN,Rokkedal J,Palmieri V,Papademetriou V,Dahl?f B,Aalto T,Gerdts E,Devereux RB.Change in diastolic left ventricular filling after one year of antihypertensive treatment:The Losartan Intervention For Endpoint Reduction in Hypertension(LIFE)Study.Circulation 2002;105:1071-1076[PMID:11877357DOI:10.1161/hc0902.104599]
34 Solomon SD,Verma A,Desai A,Hassanein A,Izzo J,Oparil S,Lacourciere Y,Lee J,Seifu Y,Hilkert RJ,Rocha R,Pitt B.Effect of intensive versus standard blood pressure lowering on diastolic function in patients with uncontrolled hypertension and diastolic dysfunction.Hypertension 2010;55:241-248[PMID:19996069DOI:10.1161/HYPERTENSIONAHA.109.138529]
35 Maron BJ,Thompson PD,Ackerman MJ,Balady G,Berger S,Cohen D,Dimeff R,Douglas PS,Glover DW,Hutter AM,Krauss MD,Maron MS,Mitten MJ,Roberts WO,Puffer JC.Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes:2007 update:a scientific statement from the American Heart Association Council on Nutrition,Physical Activity,and Metabolism:endorsed by the American College of Cardiology Foundation.Circulation 2007;115:1643-1455[PMID:17353433DOI:10.1161/CIRCULATIONAHA.107.181423]
36 Weiner RB,Hutter AM,Wang F,Kim JH,Wood MJ,Wang TJ,Picard MH,Baggish AL.Performance of the 2010 European Society of Cardiology criteria for ECG interpretation in athletes.Heart 2011;97:1573-1577[PMID:21602522 DOI:10.1136/hrt.2011.227330]