Vectorcardiographic detection of left ventricular hypertrophy in essential hypertension: Comparative analysis with electrocardiogram and echocardiogram

Abstract

Objective: This study evaluates the vectorcardiographic criteria for left ventricular hypertrophy (LVH) in patients with essential hypertension. It also simultaneously assesses the acuracy of the VCG against the most used ECG criteria in the clinical setting. Methods: From the hypertension unit of the Cardiology Division of Sao Paulo Federal University 60 consecutive patients were selected (43 women and 16 men with average age of 49 * 9.4y) with diagnosis of essential hypertension. The patients were submitted to the ECG and VCG examinations on the same day and to the M-mode echocardiogram (Echo) examination around 2 weeks. We assessed the following electrocardiographic criteria to LVH: Sokolow-Lyon voltage (sum of amplitude of the S wave on lead V1 and R wave on lead V5 or V6 * 3.5 mV; Romhilt-Estes point score with partition values of * 5 points; gender-specific Cornell voltage (S V3 + R aVL [gt ] 2.8 mV in men and [gt ] 2.0 mV in women) and Peruggia score that requires the presence at least one of the following criteria: S V3 + R aVL [gt ] 2.4 mV in men or 2.0 mV in women; left ventricular strain or Romhilt-Estes score of 5 points or more. The VCG tracings were recorded with the Hewlett Packard model 1520A with the Frank system for electrode placement. The LVH diagnosis was met when the maximum QRS vector was directed to the left and posteriorly in the transverse and to the left and inferiorly in the frontal planes with the magnitude exceeding 2 mV. The results of the Echo was taken as golden standard and LVH was determined according to the recommendation of the ASE. The cut-off value to presence of LVH was 120 and 150 mg/m2 to women and men, respectively. All examination tracings were interpreted by 3 investigators without knwoledge of other patient data. Results: Comparative Analysis Considering the Echocardiogram as Golden Standard Conclusion: The VCG was much more sensitive than any current ECG criteria. The agreement analysis showed that the VCG, with simple and practical criteria, can be an operational alternative to a reliable diagnosis of LVH in populations with essential hypertension.