Assessment Of Left Ventricular Hypertrophy Research Articles

Construction and validation of a nomogram to predict left ventricular hypertrophy in low-risk patients with hypertension.

Electrocardiography (ECG) is an accessible diagnostic tool for screening patients with hypertensive left ventricular hypertrophy (LVH). However, its diagnostic sensitivity is low, with a high probability of false-negatives. Thus, this study aimed to establish a clinically useful nomogram to supplement the assessment of LVH in patients with hypertension and without ECG-LVH based on Cornell product criteria (low-risk hypertensive population). A cross-sectional dataset was used for model construction and divided into development (n=2906) and verification (n=1447) datasets. A multivariable logistic regression risk model and nomogram were developed after screening for risk factors. Of the 4353 low-risk hypertensive patients, 673 (15.4%) had LVH diagnosed by echocardiography (Echo-LVH). Eleven risk factors were identified: hypertension awareness, duration of hypertension, age, sex, high waist-hip ratio, education level, tea consumption, hypochloremia, and other ECG-LVH diagnostic criteria (including Sokolow-Lyon, Sokolow-Lyon products, and Peguero-Lo Presti). For the development and validation datasets, the areas under the curve were 0.724 (sensitivity=0.606) and 0.700 (sensitivity=0.663), respectively. After including blood pressure, the areas under the curve were 0.735 (sensitivity=0.734) and 0.716 (sensitivity=0.718), respectively. This novel nomogram had a good predictive ability and may be used to assess the Echo-LVH risk in patients with hypertension and without ECG-LVH based on Cornell product criteria.

A fast, novel technique for detection of left ventricular hypertrophy by electrocardiography

Abstract Background Electrocardiography (ECG) is a widely used non-invasive tool for detecting left ventricular hypertrophy (LVH), but existing techniques suffer from complex rules and limited sensitivity. Purpose The goal of this study was to design and evaluate a new technique for rapid assessment of LVH by ECG. Methods The WS (Witteles-Somani) technique for LVH detection is based on recognizing the visual overlap between the S-wave of a precordial lead and the R-wave of any subsequent precordial lead. To evaluate its performance, ECGs from all patients at Stanford Healthcare with associated transthoracic echocardiograms (TTEs) between 2006 and 2018 were collected for analysis. ECGs with pre-existing bundle branch blocks or paced rhythms were excluded. A multiple adaptive thresholding technique was used to segment all QRS complexes from each ECG, with which algorithms to implement LVH detection criteria (i.e. WS, Sokolow-Lyon, Cornell, Peguero-Lo Presti) assessed performance over all ECGs. Associations between raw WS score (e.g. maximum S-wave and R-wave pair overlap value) and cardiovascular mortality, incident cardiovascular disease, and incident heart failure using age- and gender-adjusted Cox regression was also investigated. Results A total of 123,021 ECGs and 35,293 TTEs from 30,645 patients were collected. Of these ECGs, 36.1% belonged to patients with TTE-diagnosed LVH. The WS technique was more sensitive (46.1%) and had a higher F1-score (0.443) than other clinical criteria (Table 1), although with comparable calibration (AUROC 0.56 for WS vs. 0.54 for Sokolow-Lyon, 0.60 for Cornell, and 0.61 for Peguero-Lo Presti). Higher WS scores were associated with all-cause mortality (HR 1.08 [95% CI, 1.06, 1.11], P<0.005), incident cardiovascular disease (HR 1.15 [95% CI, 1.14, 1.17], P<0.005), and incident heart failure (HR 1.17 [95% CI, 1.16, 1.18], P<0.005). Conclusion The proposed WS technique is a much simpler and more sensitive technique than standard metrics to detect LVH from ECG, with important clinical implications in the development of future cardiovascular disease.Cumulative Incidence of DiseaseCriteria Classification Performance

Diagnosis and management of patients with left ventricular hypertrophy: Role of multimodality cardiac imaging. A scientific statement of the Heart Failure Association of the European Society of Cardiology.

Left ventricular (LV) hypertrophy consists in an increased LV wall thickness. LV hypertrophy can be either secondary, in response to pressure or volume overload, or primary, i.e. not explained solely by abnormal loading conditions. Primary LV hypertrophy may be due to gene mutations or to the deposition or storage of abnormal substances in the extracellular spaces or within the cardiomyocytes (more appropriately defined as pseudohypertrophy). LV hypertrophy is often a precursor to subsequent development of heart failure. Cardiovascular imaging plays a key role in the assessment of LV hypertrophy. Echocardiography, the first-line imaging technique, allows a comprehensive assessment of LV systolic and diastolic function. Cardiovascular magnetic resonance provides added value as it measures accurately LV and right ventricular volumes and mass and characterizes myocardial tissue properties, which may provide important clues to the final diagnosis. Additionally, scintigraphy with bone tracers is included in the diagnostic algorithm of cardiac amyloidosis. Once the diagnosis is established, imaging findings may help predict future disease evolution and inform therapy and follow-up. This consensus document by the Heart Failure Association of the European Society of Cardiology provides an overview of the role of different cardiac imaging techniques for the differential diagnosis and management of patients with LV hypertrophy.

Deep learning assessment of left ventricular hypertrophy based on electrocardiogram.

BackgroundCurrent electrocardiogram (ECG) criteria of left ventricular hypertrophy (LVH) have low sensitivity. Deep learning (DL) techniques have been widely used to detect cardiac diseases due to its ability of automatic feature extraction of ECG. However, DL was rarely applied in LVH diagnosis. Our study aimed to construct a DL model for rapid and effective detection of LVH using 12-lead ECG.MethodsWe built a DL model based on convolutional neural network-long short-term memory (CNN-LSTM) to detect LVH using 12-lead ECG. The echocardiogram and ECG of 1,863 patients obtained within 1 week after hospital admission were analyzed. Patients were evenly allocated into 3 sets at 3:1:1 ratio: the training set (n = 1,120), the validation set (n = 371) and the test set 1 (n = 372). In addition, we recruited 453 hospitalized patients into the internal test set 2. Different DL model of each subgroup was developed according to gender and relative wall thickness (RWT).ResultsThe LVH was predicted by the CNN-LSTM model with an area under the curve (AUC) of 0.62 (sensitivity 68%, specificity 57%) in the test set 1, which outperformed Cornell voltage criteria (AUC: 0.57, sensitivity 48%, specificity 72%) and Sokolow-Lyon voltage (AUC: 0.51, sensitivity 14%, specificity 96%). In the internal test set 2, the CNN-LSTM model had a stable performance in predicting LVH with an AUC of 0.59 (sensitivity 65%, specificity 57%). In the subgroup analysis, the CNN-LSTM model predicted LVH by 12-lead ECG with an AUC of 0.66 (sensitivity 72%, specificity 60%) for male patients, which performed better than that for female patients (AUC: 0.59, sensitivity 50%, specificity 71%).ConclusionOur study established a CNN-LSTM model to diagnose LVH by 12-lead ECG with higher sensitivity than current ECG diagnostic criteria. This CNN-LSTM model may be a simple and effective screening tool of LVH.

Left ventricular hypertrophy and incident cognitive decline in older adults with hypertension

The association between raised blood pressure and increased risk of subsequent cognitive decline is well known. Left ventricular hypertrophy (LVH), as a marker of hypertensive target organ damage, may help identify those at risk of cognitive decline. We assessed whether LVH was associated with subsequent cognitive decline or dementia in hypertensive participants aged ≥80 years in the randomized, placebo-controlled Hypertension in the Very Elderly Trial. LVH was assessed using 12-lead electrocardiography (ECG) based on the Cornell Product (CP-LVH), Sokolow-Lyon (SL-LVH), and Cornell Voltage (CV-LVH) criteria. The Mini-Mental State Examination (MMSE) was used to assess cognitive function at baseline and annually. A fall in MMSE to <24 or an annual fall of >3 points were defined as cognitive decline and triggered dementia screening (Diagnostic Statistical Manual IV). Death was defined as a competing event. Fine-Gray regression models were used to examine the relationship between baseline LVH and cognitive outcomes. There were 2645 in the analytical sample, including 201 (7.6%) with CP-LVH, 225 (8.5%) SL-LVH and 251 (9.5%) CV-LVH. CP-LVH was associated with increased risk of cognitive decline, subdistribution hazard ratio (sHR)1.3 (95% confidence interval (CI) 1.01–1.67) in multivariate analyses. SL-LVH and CV-LVH were not associated with cognitive decline (sHR1.06 (95% CI 0.82–1.37) and sHR1.13 (95% CI 0.89–1.43), respectively). LVH was not associated with dementia. LVH may be related to subsequent cognitive decline, but evidence was inconsistent depending on ECG criterion and there were no associations with incident dementia. Additional work is needed to understand the relationships between blood pressure, LVH assessment and cognition.

Relationship of a new anthropometric index with left ventricular hypertrophy in hypertensive patients among the Han Chinese

BackgroundThis study aimed to assess the relationship of a new anthropometric index with left ventricular hypertrophy (LVH) in hypertensive patients among the Han Chinese.MethodsThe study is a community-based cross-sectional study that included 4639 patients with hypertension and integrated clinical and echocardiographic data. Left ventricular (LV) mass was measured by transthoracic echocardiography. LVH was diagnosed by using the criteria of left ventricular mass indexed (LVMI) over 49.2 g/m2.7 for men and 46.7 g/m2.7 for women. Quartiles of a body shape index (ABSI), body roundness index (BRI), waist circumference (WC), and body mass index (BMI) were used regarding LVH prevalence. The logistic regression model was used to determine the odds ratio (OR) and 95% confidence intervals (CI) of the new anthropometric index and LVH. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive ability of the obesity indices for LVH risk.ResultsThe prevalence of LVH increased across quartiles for ABSI, BRI, BMI, and WC. Comparing the lowest with the highest quartile, adjusted OR (95% CI) for LVH were significantly different for BRI 3.86 (3.12–4.77), BMI 3.54 (2.90–4.31), and WC 2.29 (1.88–2.78). No association was observed for ABSI. According to ROC analysis, the area under the curve (AUC) of BRI was (AUC: 0.653, 95% CI 0.637–0.669), BMI (AUC: 0.628, 95% CI 0.612–0.644), WC (AUC: 0.576, 95% CI 0.559–0.593), ABSI (AUC: 0.499, 95% CI 0.482–0.516).ConclusionsThis study shows that LVH prevalence increased per quartile across the Han Chinese population with hypertension for ABSI, BRI, BMI, and WC. There is a significant association between BRI and LVH in hypertensive people, while ABSI was not. BRI showed potential for use as an alternative obesity measure in the assessment of LVH.

Improving the diagnostic search for the assessment of left ventricular hypertrophy in men during screening studies

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Разработать дополнительные чувствительные и специфичные электрокардиографические (ЭКГ) критерии для ранней диагностики гипертрофии левого желудочка (ГЛЖ). <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Группу наблюдения составили 184 пациента мужского пола (средний возраст 53,0±7,5 года). Проведена эхокардиография (ЭХО-КГ) на аппарате Vivid q (GE Vingmed Ultrasound AS, Норвегия) для определения ГЛЖ, ЭКГ в 12 стандартных отведениях с использованием электрокардиографа CARDIOVIT АТ-10 (Schiller FG, Швейцария) для оценки индексов ГЛЖ. Выполнены статистическая обработка данных и ROC-анализ. <h3>РЕЗУЛЬТАТЫ</h3> В обследованной когорте на основании данных ЭКГ ГЛЖ зарегистрирована только у 7,1% пациентов, данных трансторакальной ЭХО-КГ — у 45,6% пациентов. Хорошая прогностическая способность в отношении диагностики ГЛЖ показана для корнельского вольтажного индекса (AUC=0,744), средняя — для <i>R</i>aVL (AUC=0,679). Согласно матрице ROC-анализа значение точки отреза (cut-off) для <i>R</i>aVL в отношении ГЛЖ составляет 4,5 мм с чувствительностью 71% и специфичностью 56%; для корнельского вольтажного индекса это значение составляет 15,5 мм с чувствительностью 74% и специфичностью 57%. При оценке методом ROC-анализа точки отреза (cut-off) индекса массы миокарда левого желудочка (ИММЛЖ) по росту в степени 2,7 в отношении прогнозной принадлежности к группе ГЛЖ по данным двухфакторной логистической регрессионной модели получено значение AUC=0,704 (<i>p</i>=0,0001) и точки отреза ИММЛЖ с чувствительностью 68% и специфичностью 72% — 50 г/м^2,7. <h3>ВЫВОДЫ</h3> Установленные значения точек отреза (cut-off) в отношении ГЛЖ у мужчин для <i>R</i>aVL 4,5 мм и корнельского вольтажного индекса 15,5 мм позволяют прогнозировать наличие ГЛЖ у мужчин и осуществлять целенаправленную эхокардиографию.

Left Ventricular Structure is Associated with Postoperative Death After Coronary Artery Bypass Grafting in Patients with Heart Failure with Reduced Ejection Fraction

BackgroundThe relationship between abnormal left ventricular (LV) structure and adverse outcomes has been confirmed in diverse patient groups in previous studies. However, it remains uncertain whether LV structure has predictive implications in heart failure with reduced ejection fraction (HFrEF) patients with coronary artery bypass grafting (CABG).MethodsThis study retrospectively enrolled patients who had HFrEF and underwent CABG between January 2013 and July 2019. According to LV hypertrophy (LVH) and LV enlargement (LVE) assessed by echocardiography, patients were classified into four LV structure types: (-)LVH/(-)LVE, (+)LVH/(-)LVE, (-)LVH/(+)LVE, and (+)LVH/(+)LVE.ResultsA total of 435 consecutive patients (mean age: 59.4 ± 9.6 years; 14.9% female) were enrolled in the present study. Examined independently, either LVH (p < 0.001) or LVE (p < 0.001) was independently associated with postoperative mortality in multivariate analysis. When LVH and LVE were analyzed in combination, the risk of mortality after CABG was lowest in (-)LVH/(-)LVE and increased with (+)LVH/(-)LVE (odds ratio [OR]: 7.525; 95% confidence interval [CI]: 1.827–30.679, p = 0.004), (-)LVH/(+)LVE (OR: 7.253; 95% CI: 1.950–27.185, p = 0.003), and (+)LVH/(+)LVE (OR: 9.547; 95% CI: 2.726–34.805, p < 0.001), independent of other risk factors. Adding LV structural types to the baseline model gained an incremental effect on the predictive value for postoperative mortality (AUC: baseline model, 0.838 vs baseline model + LV structural types, 0.901, p for comparison = 0.010; category‐free net reclassification improvement (NRI): 0.764, p < 0.001; integrated discrimination improvement (IDI): 0.061, p = 0.007).ConclusionLVH and LVE were associated with an increased risk of postoperative mortality after CABG in patients with HFrEF. Categorizing LV structural patterns with LVH and LVE contributes to risk stratification and provides incremental predictive ability. Routine echocardiographic assessment of LVH and LVE is needed in clinical practice.

Clinical utility of 12-lead electrocardiogram in evaluating heart disease in patients with muscular dystrophy: Assessment of left ventricular hypertrophy, conduction disease, and cardiomyopathy.

IntroductionHeart disease remains a leading cause of mortality in patients with muscular dystrophy (MD), and cardiac assessment by standard imaging modalities is challenging due to the prominence of physical limitations.MethodsIn this prospective cohort study of 169 MD patients and 34 negative control patients, we demonstrate the clinical utility of a 12‐lead electrocardiogram (ECG) as an effective modality for the assessment of cardiac status in patients with MD. We assessed the utility of conventional criteria for electrocardiogram‐indicated left ventricular hypertrophy (ECG‐LVH) as well as ECG morphologies.ResultsCornell voltage, Cornell voltage‐duration, Sokolow–Lyon voltage, and Romhilt‐Estes point score criteria demonstrated low sensitivity and minimal positive predictive value for ECG‐LVH when compared with cardiac imaging. Patients with LBBB had a high probability of a cardiomyopathy (relative risk [RR], 2.75; 95% confidence interval [CI], 2.14–3.53; p < .001), and patients with QRS fragmentation (fQRS) had a high probability of a cardiomyopathy (RR, 1.76; 95% CI, 1.20–2.59; p = .004), requiring cardiac medication and device intervention. We found that an R/S ratio >1 in V1 and V2 is highly specific (specificity, 0.89; negative predictive value [NPV], 0.89 and specificity, 0.82; NPV, 0.89, respectively) for patients with dystrophinopathies compared with other types of MD.ConclusionThe identification of LBBB and fQRS was linked to cardiomyopathy in patients with MD, while ECG‐LVH was of limited utility. Importantly, these findings can be applied to effectively screen a broad cohort of MD patients for structural heart disease and prompt further evaluation and therapeutic intervention.

VALUE OF DIFFERENT ECHOCARDIOGRAPHIC MODALITIES IN THE ASSESSMENT OF LEFT VENTRICULAR HYPERTROPHY IN HYPERTENSIVE PATIENTS WITH TYPE II DIABETES MELLITUS

Background: Left ventricular hypertrophy (LVH) is the response of myocytes to various stimuli leading to myocytes’ hypertrophy, which occurs as a compensatory response to increased after-load. It is defined as an increase in LV mass assessed by postmortem measurements, electrocardiographic (ECG), echocardiographic and cardiovascular magnetic resonance (CMR) criteria. Objective: To investigate the reproducibility of different echocardiographic modalities in the assessment of LVH in hypertensive patients and patients with type II DM in comparison to the golden standard CMR measurements. Patients and Methods: We prospectively investigated 40 patients with LVH, 20 patients being hypertensive and diabetic, 20 patients being diabetic only and 20 healthy control subjects (normal ventricular function and ECG and no cardiac risk factors). In addition to clinical and conventional echocardiographic parameters, LV mass and volumes were analyzed. Results: The comparison between new echocardiographic techniques and CMR showed that the assessments of LV volumes/LVEF by echocardiography and CMR have good correlations. However, the inter-technique agreement of absolute LV volumes revealed considerable differences, with significant underestimation of volumes and LVEF with respect to CMR. The LV mass was less in patients assessed by different algorithms of 2D echo rather than 3D echo and CMR, correlated positively with EDV and ESV. Conclusion: 3D echocardiography attains more solid results in patients diagnosed having LVH by 2D echocardiography. CMR would be preferable for research and specific clinical conditions requiring higher accuracy and reproducibility.

Multi-parametric assessment of left ventricular hypertrophy using late gadolinium enhancement, T1 mapping and strain-encoded cardiovascular magnetic resonance

AimTo evaluate the ability of single heartbeat fast-strain encoded (SENC) cardiovascular magnetic resonance (CMR) derived myocardial strain to discriminate between different forms of left ventricular (LV) hypertrophy (LVH).Methods314 patients (228 with hypertensive heart disease (HHD), 45 with hypertrophic cardiomyopathy (HCM), 41 with amyloidosis, 22 competitive athletes, and 33 healthy controls) were systematically analysed. LV ejection fraction (LVEF), LV mass index and interventricular septal (IVS) thickness, T1 mapping and atypical late gadolinium enhancement (LGE) were assessed. In addition, the percentage of LV myocardial segments with strain ≤ − 17% (%normal myocardium) was determined.ResultsPatients with amyloidosis and HCM exhibited the highest IVS thickness (17.4 ± 3.3 mm and 17.4 ± 6 mm, respectively, p < 0.05 vs. all other groups), whereas patients with amyloidosis showed the highest LV mass index (95.1 ± 20.1 g/m2, p < 0.05 vs all others) and lower LVEF compared to controls (50.5 ± 9.8% vs 59.2 ± 5.5%, p < 0.05). Analysing subjects with mild to moderate hypertrophy (IVS 11–15 mm), %normal myocardium exhibited excellent and high precision, respectively for the differentiation between athletes vs. HCM (sensitivity and specificity = 100%, Area under the curve; AUC%normalmyocardium = 1.0, 95%CI = 0.85–1.0) and athletes vs. HHD (sensitivity = 83%, specificity = 75%, AUC%normalmyocardium = 0.85, 95%CI = 0.78–0.90). Combining %normal myocardial strain with atypical LGE provided high accuracy also for the differentiation of HHD vs. HCM (sensitivity = 82%, specificity = 100%, AUCcombination = 0.92, 95%CI = 0.88–0.95) and HCM vs. amyloidosis (sensitivity = 83%, specificity = 100%, AUCcombination = 0.83, 95%CI = 0.60–0.96).ConclusionFast-SENC derived myocardial strain is a valuable tool for differentiating between athletes vs. HCM and athletes vs. HHD. Combining strain and LGE data is useful for differentiating between HHD vs. HCM and HCM vs. cardiac amyloidosis.

Dynamics of left ventricle myocardial deformation, soluble ST2 and cardiotrophin-1 in hypertensive women on combined valsartan/hydrochlorothiazide therapy

Abstract Funding Acknowledgements Type of funding sources: None. Background. The treatment-induced regression of left ventricular hypertrophy (LVH) is associated with improved prognosis in patients with arterial hypertension. However, the assessment of LVH by echo is restricted by substantial measurement variability and low sensitivity to changes during follow-up. The alternative approach could be the dynamic evaluation of myocardial deformation parameters and biochemical markers of cardiac remodeling. The purpose of this study was to assess the dynamics of left ventricle (LV) myocardial deformation, soluble ST2 and cardiotrophin-1 levels in hypertensive women treated with combination of valsartan/hydrochlorothiazide. Methods. The study involved 100 postmenopausal women (mean age – 57.7 ± 4.3 years) with uncomplicated arterial hypertension. All patients were treated with combination of valsartan (80-320 mg; average dose 195 mg) and hydrochlorothiazide (12.5 mg). Ambulatory blood pressure monitoring, conventional and 2-dimensional speckle tracking echocardiography were performed before and 6 months after treatment. The concentrations of cardiotrophin-1 and soluble ST2 were determined by ELISA method. The data are presented as median and interquartile range. Results. Treatment with valsartan/hydrochlorothiazide was effective and well tolerated. Target blood pressure level was achieved in 64 % of the patients. The LV global longitudinal strain (GLS) raised significantly after 6 months of treatment (Table). We found the reduction of mechanical dispersion - parameter, which indirectly reflects myocardial tissue homogenicity. The levels of circulating cardiotrophin-1 and soluble ST2 decreased by 37.93% and 19.74%, respectively (p &amp;lt; 0.0001). Conclusions. The 6-month therapy with valsartan/hydrochlorothiazide was associated with improvement of myocardial deformation parameters with concomitant reduction of soluble ST-2 and cardiotrophin-1 levels. These markers could be more sensitive than standard parameters for hypertensive patients" follow-up. However, this approach should be confirmed in future studies. Parameter Baseline 6-month p Office SBP, mm Hg 148 (140; 157) 135 (124; 143) &amp;lt;0.0001 Office DBP, mm Hg 89 (82; 96) 81 (74; 87) &amp;lt;0.0001 LV GLS, % -19.6 (-18.1; -21.1) -20.4 (-18.9; -21.8) 0.01 Mechanical dispersion, ms 43 (37; 51) 41 (37; 48) 0.04 Cardiotrophin-1, pg/ml 12.2 (9.4; 16.81) 8.5 (6.26; 10.82) &amp;lt;0.0001 Soluble ST2, ng/ml 25.3 (17.93; 29.72) 18.2 (13.93; 25.96) &amp;lt;0.0001 Values are given as median and interquartile range

Modified Cornell electrocardiographic criteria in the assessment of left ventricular hypertrophy geometry of patients with essential hypertension.

To evaluate the value of modified Cornell electrocardiographic criteria in the assessment of left ventricular hypertrophy (LVH) for patients with essential hypertension. A total of 381 patients with essential hypertension diagnosed in our hospital were selected. Using the left ventricle (LV) geometric patterns classified by the American Society of Echocardiography (ASE), we examined the distribution of the modified Cornell criteria of Ravl + SD (the deepest S wave in 12‐lead ECG) in different geometric patterns and analyzed the correlation of modified Cornell criteria with changes in the LV geometric patterns using multiple linear regression analysis. The distribution of modified Cornell criteria, Sokolow‐Lyon criteria (RV5/V6 + SV1), and Cornell criteria (Ravl + SV3) in gender‐specific hypertensive geometric patterns were significantly different (P ≤ .01 for all). The voltage of Ravl + SD in male patients showed an increase trend in the normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH) groups, and this increase trend was significantly in the unadjusted model and the adjusted model. The voltages of Ravl + SV3 and RV5/V6 + SV1 of male patients in CR, CH and RH groups showed a gradual increase trend, but the increase trend in CR group has no statistical significance compared to that in NG group (P ≥ .05). The voltages of Ravl + SD, RV5/V6 + SV1, and Ravl + SV3 in female patients in CR, CH and EH groups showed a trend of increase after decrease in the adjusted model. In conclusion, the modified Cornell criteria could dynamically reflect left ventricular hypertensive geometry of male patients.

The use of cardiovascular magnetic resonance for the assessment of left ventricular hypertrophy.

Cardiovascular magnetic resonance (CMR) is a powerful tool to assess and diagnose the cause of left ventricular hypertrophy (LVH). This review provides an overview of the typical CMR findings in the various causes of LVH, focusing mainly on late gadolinium enhancement (LGE) imaging. It will also cover the more novel techniques of T1 mapping, extracellular volume (ECV) fraction estimation and diffusion tensor imaging (DTI) and their role in the imaging assessment of LVH.

Assessment of Left Ventricular Hypertrophy (LVH) Criteria by Surface Electrocardiography in a Sample of Iraqi Patients with Systemic Arterial Hypertension.

Background:Left ventricular hypertrophy (LVH) in hypertensive patients indicates an ongoing disease process involving the heart. Different electrocardiography (ECG) criteria were investigated; however, the results were conflicting.Objective:To evaluate different ECG criteria in diagnosis of LVH in hypertensive patients using echocardiography as a gold standard.Methods:A hospital based cross sectional observational study which included 140 adult patients with a history of hypertension. Patients were assessed for LVH using five ECG criteria: Romhilt-Estes, SokoloweLyon, Cornell voltage, Gubnere Ungerleider and Peguero-Lo Presti. Echocardiography was used to determine the left ventricular mass index for the patients. The sensitivity and specificity of each ECG criterion was determined considering echocardiography as a gold standard.Results:According to the echocardiographic results, 83 patients (59.29%) were found to have LVH. Age over 40 years, overweight and obesity, high systolic blood pressure (>170 mmHg) and using of antihypertensive drugs were significantly associated with the increased risk of LVH. All included ECG criteria showed low sensitivity and high specificity in detection of LVH in hypertensive patients. There were no significant differences in the efficiency of different ECG criteria in discrimination between mild, moderate and severe cases of LVH.Conclusion:LVH is very common among hypertensive patients, and the sensitivity of ECG criteria is low for these criteria to be clinically used for detection of LVH with high specificity, in which Cornell criterion is the best in detection.

Conventional and new electrocardiographic criteria for hypertension-mediated cardiac organ damage: A narrative review.

Hypertension-mediated organ damage (HMOD) is frequently observed in hypertensive patients at different cardiovascular (CV) risk profile. This may have both diagnostic and therapeutic implications for the choice of the most appropriate therapies. Among different markers of HMOD, the most frequent functional and structural adaptations can be observed at cardiac level, including left ventricular hypertrophy (LVH), diastolic dysfunction, aortic root dilatation, and left atrial enlargement. In particular, LVH was shown to be a strong and independent risk factor for major CV events, namely myocardial infarction, stroke, congestive heart failure, CV death. Thus, early identification of LVH is a key element for preventing CV events in hypertension. Although echocardiographic assessment of LVH represents the gold standard technique, this is not cost-effective and cannot be adopted in routine clinical practice of hypertension. On the other hand, electrocardiographic (ECG) assessment of HMOD relative to the heart is a simple, reproducible, widely available and cost-effective method to assess the presence of LVH, and could be preferred in large scale screening tests. Several new indicators have been proposed and tested in observational studies and clinical trials of hypertension, in order to improve the relatively low sensitivity of the conventional ECG criteria for LVH, despite high specificity. This article reviews the differences in the use of the main conventional and the new 12 lead ECG criteria of LVH for early assessment of asymptomatic, subclinical cardiac HMOD in a setting of clinical practice of hypertension.

Short-term repeatability of electrocardiographic criteria of left ventricular hypertrophy.

Left ventricular hypertrophy (LVH) is a marker of cardiac end-organ damage and a risk factor for cardiovascular morbidity and mortality. Although clinical trials and cohort studies commonly use the electrocardiogram (ECG) for LVH assessment, the repeatability of ECG-LVH criteria has not been sufficiently examined. Therefore, we evaluated the repeatability of ECG-LVH criteria. Participants (n=63) underwent two standard ECGs at each of two visits, two weeks apart. The ECGs were processed centrally to calculate Cornell voltage (CV) LVH, Cornell voltage product (CVP) LVH, Sokolow-Lyon (SL) LVH, and Sokolow-Lyon product (SLP) LVH. We also used the waveforms measurements contributing to these LVH criteria as continuous variables, referred to here as CV-index, CVP-index, and SL-index. We calculated the intraclass correlation coefficient (ICC), minimal detectable change (95% confidence), and the prevalence-adjusted bias-adjusted kappa (PABAK). ICCs (95% confidence intervals (CI)) were 0.97 (0.96, 0.98) for CV-index, 0.97 (0.95, 0.98) for CVP-index, and 0.93 (0.90, 0.96) for log of SL-index. Minimal detectable change between repeat measures of CV-index, CVP-index, and log of SL-index were ≥236.7mV, ≥26.7mV, and ≥0.09mV, respectively. The within-visit PABAK was 1 for all ECG-LVH criteria, except for the first visit SLP-LVH (PABAK=0.93). Between-visit PABAK ranged from 0.83 to 0.97 across LVH criteria. CV, CVP, and SL ECG-LVH as continuous variables have excellent repeatability, and as binary variables have excellent within-visit agreement and good between-visit agreement. These results alleviate concerns about the repeatability the ECG-LVH use in clinical trials and epidemiologic studies.

Assessment of Left Ventricular Hypertrophy and Dysfunction in Patients of Chronic Kidney Disease

Assessment of Left Ventricular Hypertrophy and Dysfunction in Patients of Chronic Kidney Disease

Left ventricular hypertrophy identified by cardiac computed tomography and ECG in hypertensive individuals: a population-based study.

Screening of left ventricular hypertrophy (LVH) is a biomarker of organ damage in hypertensive individuals and associated with increased mortality. Cardiac computed tomography (CT) is widely expanding worldwide; however, the value of CT assessment of LVH is unknown. We aimed to identify individuals with LVH using both cardiac CT and electrocardiograms (ECG) and to explore potential differences between these phenotypical distinct diagnostic modalities. Participants in the Copenhagen General Population Study underwent 12-lead ECG and cardiac CT and were evaluated for the presence of LVH. Multiple ECG signs of LVH were compared with LVH by CT. Out of 4942 participants, 1347 had untreated hypertension and in this group, 13% presented with anatomical LVH by CT and 10% by ECG with an overlap of 4%. ECG signs of LVH had negative predictive values between 87 and 89% compared with CT. Using a combination of the Sokolow-Lyon index, the Cornell voltage duration product and/or a Romhilt-Estes score at least 4, lead to an increased C-statistics (P < 0.001) compared with the use of any single ECG sign of LVH. Individuals with solely CT but not ECG signs of LVH had higher SBPs (152 vs. 144 mmHg, P < 0.001) and larger left atria (49 vs. 45 ml/m, P < 0.001) compared with individuals with solely ECG LVH. CT and ECG identifies LVH in 19% of hypertensive individuals with only a small diagnostic overlap. Commonly used ECG criteria for LVH cannot safely rule out the presence of anatomical LV organ damage.

Association between plasma microRNA-29a and left ventricular hypertrophy in patients with hypertension

Objective: Previous studies have shown that plasma microRNA-29a (miRNA-29a) is associated with myocardial fibrosis and the degree of cardiac hypertrophy in patients with hypertrophic cardiomyopathy. However, the relationship between plasma miRNA-29a and hypertensive left ventricular hypertrophy (LVH) has not yet been reported. So the purpose of this study is to investigate the relationship between the plasma miRNA-29a and hypertensive LVH. Method: Enrolled 168 hypertensive patients and classified the patients into 2 groups: those with LVH (LVH group, n=41) and those without LVH (NLVH group, n=127). All patients underwent echocardiography examination. Left ventricular mass index (LVMI) was calculated by interventricular septal thickness (IVSd), left ventricular posterior wall thickness(LVPWTd), left ventricular end diastolic dimension (LVEDD) and left ventricular mass index (LVMI) were obtained. Plasma levels of miRNA-29a were assessed by quantitative real-time polymerase chain reaction (qRT-PCR). The relationship between plasma miRNA-29a levels and LVH was analyzed. Results: Plasma miRNA-29a was significantly higher in LVH group than in NLVH group (0.52±0.10 vs. 0.37±0.07, t=9.788, P<0.01) . Pearson correlation analysis evidenced a positive correlation between plasma miRNA-29a levels and IVSd(R=0.459, P<0.01), LVPWTd (R=0.398, P<0.01), and LVMI (R=0.745, P<0.01). After adjustment for gender, age, systolic blood pressure, diastolic blood pressure, body mass index, hypertension duration, antihypertensive drugs, multiple regression analysis showed that there were still positive correlations between plasma miRNA-29a level and IVSd (β=0.535, P<0.01), LVPWTd (β=0.085, P<0.01), and LVMI (β=0.806, P<0.01). Conclusion: Plasma miRNA-29a level is positively associated with LVH in hypertensive patients, and future studies are warranted to explore if miRNA-29a could be used as a potential biomarker for LVH assessment in hypertensive patients.