Abstract
BackgroundLeft ventricular hypertrophy (LVH) is a hallmark of chronic pressure or volume overload of the left ventricle and is associated with risk of cardiovascular morbidity and mortality. The purpose was to evaluate different electrocardiographic criteria for LVH as determined by cardiovascular magnetic resonance (CMR). Additionally, the effects of concentric and eccentric LVH on depolarization and repolarization were assessed.Methods120 patients with aortic valve disease and 30 healthy volunteers were analysed. As ECG criteria for LVH, we assessed the Sokolow-Lyon voltage/product, Gubner-Ungerleider voltage, Cornell voltage/product, Perugia-score and Romhilt-Estes score.ResultsAll ECG criteria demonstrated a significant correlation with LV mass and chamber size. The highest predictive values were achieved by the Romhilt-Estes score 4 points with a sensitivity of 86% and specificity of 81%. There was no difference in all ECG criteria between concentric and eccentric LVH. However, the intrinsicoid deflection (V6 37 ± 1.0 ms vs. 43 ± 1.6 ms, p < 0.05) was shorter in concentric LVH than in eccentric LVH and amplitudes of ST-segment (V5 -0.06 ± 0.01 vs. -0.02 ± 0.01) and T-wave (V5 -0.03 ± 0.04 vs. 0.18 ± 0.05) in the anterolateral leads (p < 0.05) were deeper.ConclusionBy calibration with CMR, a wide range of predictive values was found for the various ECG criteria for LVH with the most favourable results for the Romhilt-Estes score. As electrocardiographic correlate for concentric LVH as compared with eccentric LVH, a shorter intrinsicoid deflection and a significant ST-segment and T-wave depression in the anterolateral leads was noted.
Highlights
Left ventricular hypertrophy (LVH) is a hallmark of chronic pressure or volume overload of the left ventricle and is associated with risk of cardiovascular morbidity and mortality
Patient characteristics: LV structure and LVH prevalence by cardiovascular magnetic resonance (CMR) Table 2 depicts the CMR characteristics of the 120 patients and 30 volunteers examined in the present study
LVH prevalence by ECG and correlation between ECG scores and LV structure The prevalence of LV hypertrophy according to ECG varied markedly across the different criteria, ranging from 33% for Gubner/Ungerleider, 45% for Sokolow-Lyon product, 49% for Cornell voltage, 52% for Sokolow-Lyon voltage, 53% for Cornell product, 61% for Romhilt-Estes Score 5 points, 76% for Perugia score to 80% for RomhiltEstes score 4 points
Summary
Left ventricular hypertrophy (LVH) is a hallmark of chronic pressure or volume overload of the left ventricle and is associated with risk of cardiovascular morbidity and mortality. The purpose was to evaluate different electrocardiographic criteria for LVH as determined by cardiovascular magnetic resonance (CMR). Left ventricular hypertrophy (LVH) is a hallmark of chronic pressure or volume overload of the left ventricle and is associated with a markedly elevated risk of cardiovascular morbidity and mortality. The validation of the ECG criteria was mostly based on M-mode or 2D echocardiography for estimation of left ventricular mass (LVM) [3,4,5]. Today there is no doubt that cardiovascular magnetic resonance (CMR) is a more accurate and reproducible tool to quantify LVM because of the excellent visibility and the lack of geometric assumptions [6,7]. CMR is currently deemed the gold standard for in-vivo measurements of LV mass
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