Abstract
Background: Peguero electrocardiographic left ventricular hypertrophy (ECG-LVH) criteria are newly developed criteria that have shown better diagnostic performance than the traditional Cornell-voltage and Sokolow-Lyon criteria. However, prediction of poor outcomes rather than detection of increased left ventricular mass is becoming the primary use for ECG-LVH criteria which requires investigating any new ECG-LVH criteria in terms of prediction.Aims: To examine the prognostic significance of the newly developed Peguero ECG-LVH criteria.Methods: We compared the prognostic significance of Peguero ECG-LVH with Cornell-voltage and Sokolow-Lyon ECG-LVH criteria in 7,825 participants (age 59.8 ± 13.4 years; 52.7% women) from the third National Health and Nutrition Examination Survey who were free of major intraventricular conduction defects. ECG-LVH criteria were derived from digital ECG tracings processed at a central core laboratory.Results: At baseline, ECG-LVH was detected in 11.8% by Peguero; in 4.3% by Cornell voltage and in 6.4% by Sokolow-Lyon. During a median follow up of 13.8 years, 2,796 all-cause mortality events occurred. In multivariable models adjusted for demographics and cardiovascular risk factors, presence of Peguero ECG-LVH was associated with increased risk of all-cause mortality [HR (95% CI): 1.29 (1.16, 1.44)]. This association was not significantly different from the associations of Cornell voltage-LVH or Sokolow-Lyon LVH with all-cause mortality [HR (95%CI): 1.32 (1.12, 1.55) and 1.24 (1.07, 1.43), respectively; p-values for comparisons of these HRs with the HR of Peguero ECG-LVH 0.817 and 0.667, respectively]. Similar patterns of associations were observed with cardiovascular, ischemic heart disease and heart failure mortalities.Conclusion: Peguero ECG-LVH is predictive of increased risk of death similar to the traditional ECG-LVH criteria.
Highlights
Despite the low sensitivity of electrocardiogram (ECG) to detect left ventricular hypertrophy (LVH), ECG remains the most commonly used method for LVH screening owing to its low cost and wide availability [1]
In multivariable models adjusted for demographics and cardiovascular risk factors, presence of Peguero electrocardiographic LVH (ECG-LVH) was associated with increased risk of all-cause mortality [HR: 1.29 (1.16, 1.44)]
Peguero ECG-LVH was associated with increased risk of cardiovascular, ischemic heart disease, and heart failure mortalities [HRs: 1.29 (1.16, 1.44), 1.53 (1.31, 1.80), 1.40 (1.13, 1.73), and 2.35 (1.36, 4.06), respectively]. These associations were not significantly different from the associations observed with Cornell voltage ECG-LVH [HRs (95%CI): 1.32 (1.12, 1.55), 1.39 (1.11, 1.75), 1.19 (0.86, 1.64), 3.04 (1.55, 5.95); p-values for comparisons of HRs with Peguero ECG-LVH = 0.817, 0.505, 0.407, 0.561, respectively] or SokolowLyon ECG-LVH [HRs (95%CI): 1.24 (1.07, 1.43), 1.35 (1.10, 1.66), 0.09 (0.82, 1.46), 2.68 (1.41, 5.12); p-values for comparisons of HRs with Peguero ECG-LVH = 0.667, 0.351, 0.172, 0.762, respectively]. In this analysis from the NHANES-III we examined the prognostic significance of Peguero ECG-LVH, newly developed ECG-LVH criteria with superior diagnostic accuracy compared to traditional ECG-LVH criteria [8]
Summary
Despite the low sensitivity of electrocardiogram (ECG) to detect left ventricular hypertrophy (LVH), ECG remains the most commonly used method for LVH screening owing to its low cost and wide availability [1]. Due to the better performance of ECG-LVH to predict poor outcomes more than its ability to detect anatomy (i.e., diagnose LVH), it has been suggested that risk stratification and prediction should be the primary use for ECG-LVH criteria [2]. This has been underscored in the current ECG interpretation guidelines which recommend developing new ECG-LVH criteria for sole purpose of prediction [9]. Peguero electrocardiographic left ventricular hypertrophy (ECG-LVH) criteria are newly developed criteria that have shown better diagnostic performance than the traditional Cornell-voltage and Sokolow-Lyon criteria. Prediction of poor outcomes rather than detection of increased left ventricular mass is becoming the primary use for ECG-LVH criteria which requires investigating any new ECG-LVH criteria in terms of prediction
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