Prognostic role of Sokolow-Lyon criterion in further development of the left ventricular concentric hypertrophy in adolescents with arterial hypertension

Abstract

Objective – to determine the possibility of Sokolow-Lyon criterion for forecast of the concentric Left Ventricular Hypertrophy (LVH) development in young hypertensive patients. The investigation has been organized as a prospective support of teenagers aged 16-17 yr within 3 years. Materials and Methods. Methods of the study were multiple office blood pressure measurements, daily blood pressure monitoring with electronic device, ECG and ultrasound. 47 males and females teens with firstly diagnosed primary arterial hypertension not treated before were enrolled. Primary labile hypertension diagnosed in 10 males and 11 females and 18 males and 8 females had stable hypertension. For all patients the electrocardiographic study was performed. The positive Sokolow-Lyon criterion was considered as a sum in height of S1 and R5 or R6 waves in standard chest leads excessed34 mm. Watching teens conducted during 3 years. Results. Sokolow-Lyon criterion >34 mm (3.4 mV) was identified as positive in 8 males with a stable and 6 with a labile hypertension, also it was the same in 6 females, all of them had stable hypertension. Morphological and functional left ventricular parameters in patients were minimal and appeared only as a mild thickening of the myocardial wall of the left ventricle. Only one girl who was positive by Sokolow-Lyon criterion had LVH and was excluded from the study. Repeated clinical and instrumental examination was carried out in 46 persons over 3 years to the age of 21 years. New ultrasound investigation showed the left ventricular hypertrophy development in 18 young men and 5 women with stable hypertension. The odds ratio for the development of concentric hypertrophy of the left ventricle during 3 years of the young people with diagnosed in adolescence index Sokolow-Lyon >34 mm was 8.906 with a 95% confidence interval 2.24-35.33 (p < 0.05). The sensitivity of Sokolow-Lyon criterion in predicting of the left ventricular hypertrophy during 3 years was 82.6 %, specificity 65.2 %, accuracy 74.0 %. Conclusions. The revealing of the positive Sokolow-Lyon criterion in adolescents with primary arterial hypertension may precede the development of ultrasound signs of the left ventricular hypertrophy and that should be used as an additional indication of the risk stratification of disease progression during adolescence.