いつもの心電図の「自動判定」に、右心の異常を疑う手がかり〜医学部6年生が単著で国際誌に発表、約4万2千人のデータを解析〜

2026-10-28

2026-10-27 九州大学

九州大学医学部医学科6年の渕上由祐氏は、約4万2千人の入院患者データを解析し、心電図の自動判定が右心の異常を見つける手がかりとなる可能性を示した。米国の入院患者42,078人について、心電図と心エコーの計68,905組のデータを分析し、「右軸偏位」または「右室肥大」の判定表示と、肺高血圧を疑う心エコー所見などとの関連を調べた。その結果、年齢や持病などを考慮した解析で、肺高血圧を疑う所見の推定割合は、2つの判定の少なくとも一方が表示された場合に30.0％、どちらも表示されない場合に18.8％となり、約1.6倍の差が認められた。これらの判定は、右心室の拡大や機能低下とも関連していた。日常診療で得られる心電図の自動判定を、心エコーなどの精密検査を検討するきっかけとして活用できる可能性がある。ただし、今回示されたのは関連性であり、診断精度や長期的な予後への有用性、日本国内の患者への適用については、さらなる検証が必要である。

＜関連情報＞

機械による心電図上の右軸偏位または右室肥大、および心エコー図上の肺高血圧症表現型と右心異常 Machine-Reported Electrocardiographic Right Axis Deviation or Right Ventricular Hypertrophy and Echocardiographic Pulmonary Hypertension Phenotypes and Right-Heart Abnormalities

Yoshihiro Fuchigami
Echocardiography Published: 13 July 2026
DOI:https://doi.org/10.1111/echo.70539

Abstract

Purpose
Machine-reported electrocardiographic findings suggesting right-heart strain are routinely generated during electrocardiogram (ECG) acquisition, but their relationship to echocardiographic pulmonary hypertension phenotypes and right-heart abnormalities remains incompletely defined. This study evaluated whether machine-reported right axis deviation (RAD) or right ventricular hypertrophy (RVH) is associated with echocardiographic pulmonary hypertension phenotypes and right-heart abnormalities in hospitalized patients.

Methods
This retrospective observational study used linked MIMIC-IV-ECG and MIMIC-IV-ECHO data. Echocardiograms were linked to the closest ECG obtained from 7 days before echocardiography through the time of echocardiography. The primary exposure was machine-reported RAD or RVH. The primary outcome was Echo-PH specific, a composite echo-derived phenotype including tricuspid regurgitation velocity greater than 3.4 m/s, moderate or severe pulmonary hypertension text, or right ventricular pressure overload. Logistic regression adjusted for demographics, comorbidities, and ICU status, with patient-level cluster-robust standard errors.

Results
The cohort included 68 905 ECG–echocardiography pairs from 42 078 patients; 2815 pairs were RAD/RVH-positive. For Echo-PH specific, RAD/RVH had sensitivity 7.5%, specificity 96.7%, positive predictive value 35.5%, and negative predictive value 81.4%. RAD/RVH remained associated with Echo-PH specific after full adjustment using cluster-robust standard errors (odds ratio, 2.04; 95% confidence interval, 1.84–2.26). The adjusted probability of Echo-PH specific was 18.8% without RAD/RVH and 30.0% with RAD/RVH.

Conclusion
Machine-reported ECG RAD/RVH was highly specific but insensitive for echocardiographic pulmonary hypertension phenotypes and right-heart abnormalities. These routine ECG findings may serve as supportive clues to echocardiographic right-heart disease but should not be used to exclude it.