Abstract 17332: Are Current Electrocardiographic Criteria For Detecting LVH Relevant in African Americans? Evidence From the Jackson Heart Study

Abstract

Left Ventricular Hypertrophy (LVH) is a major risk factor for cardiac arrhythmias, heart failure, and sudden death. The current gold standard for detecting LVH is echocardiography, but individuals can be first screened using a resting electrocardiogram (ECG). The current algorithm for detecting LVH by ECG is derived from the nearly all-Caucasian Framingham Heart Study (FHS).The use of Framingham ECG criteria to predict LVH in African Americans (AA) has not been validated. We tested whether Framingham ECG criteria used to detect LVH performed as well in AA. The Jackson Heart Study is a population-based study of AA, consisting of 1941 men and 3360 women. Linear regression analysis of five different ECG LVH criteria proposed in FHS, correlated left ventricular mass (LVM) on M-mode echocardiogram with ECG voltage before and after adjusting for BMI and age. Limb and chest leads voltages in JHS men and women, in comparison to the FHS men and women, showed S wave leads in V3, V4, in men, and V2 and V3 in women have the strongest correlation to LVM (P value< .0001). Among the limb leads, the JHS results were similar to the Framingham cohort, showing RI, SIII and RAVL most strongly associated with LVM in both sexes (P value<.0001). Sensitivity was calculated for five ECG criteria before and after adjusting for BMI and age using the definition of LVH as 2SD above the height- adjusted, sex specific JHS mean (95% specificity). Two of the ECG criteria, RAVL+SV3 and (RAVL+SV3)x QRS duration, in both men and women, had significantly greater sensitivities before and after adjusting than their FHS counterparts. JHS data identified ECG criteria (RAVL+SV3)x QRS duration to have the greatest sensitivity in both sexes unadjusted and adjusted for BMI and age (males 28.3% unadjusted, 71.4% adjusted; females 29.4% unadjusted and 60.3% adjusted). The data suggest that current criteria used to define LVH in a Caucasian population, (RAVL+SV3)x QRS duration, is at least as sensitive at the same level of specificity in African American populations and perhaps more so. These data support the utility of current LVH criteria for use in LVH screening in African American men and women.