Diagnosis Of LVH Research Articles

Performance of electrocardiographic criteria for detecting LVH in hypertensive Africans.

To evaluate the performance of the currently accepted LVH electrocardiographic (ECG) criteria from ethnic-specific normal values. We included 309 hypertensive subjects with both ECG (12‑leads device) and echocardiographic analysis. The diagnosis of LVH was established by echocardiography from specific norms. Current ECG criteria for the diagnosis of LVH have low performances. Area Under Curve of Sokolow-Lyon, Peguero-Lo Presti, Cornell voltage and Cornell Product were respectively 0.61, 0.65, 0.72 and 0.71. In hypertensive African, the most accurate criterion for diagnosing LVH is Cornell voltage.

Intelligent detection of left ventricular hypertrophy from pediatric echocardiography videos

AbstractLeft ventricular hypertrophy (LVH) is a common clinical manifestation associated with cardiovascular adverse events. Relying solely on the subjective judgment, it is challenging to promptly and accurately diagnose mild LVH. Quantitatively measuring the interventricular septum and left ventricular posterior wall to diagnose mild LVH is a time‐consuming and labor‐intensive process that is prone to errors. To propose a novel method for rapid and automatic end‐to‐end diagnosis of mild LVH. We propose a novel end‐to‐end automated method for detecting mild LVH. This method achieves rapid end‐to‐end detection of mild LVH in echocardiographic videos without the need for quantitative measurements. Initially, representative frames are extracted from echocardiographic videos, and these frames are then automatically diagnosed by the proposed network to detect LVH. The network architecture primarily consists of three key components: a feature extractor, bidirectional LSTM, and attention module. The Vit‐b model achieved 88% video classification accuracy in the experiment where 32 frames are extracted, and the ViT‐l model achieves 92% video classification accuracy in the experiment where 16 frames are extracted. It is shown experimentally that extracting fewer video frames can diagnose LVH more accurately. The experiments illustrate the superior performance and competitiveness of this method compared to other approaches, potentially applicable to the clinic.

Abstract P365: Left Ventricular Hypertrophy In Hypertension-correlation Of Electrocardiography Criteria, Echocardiography And Myocardial Strain Imaging

Background: LVH on ECG has been defined by 37 different criteria with modest degree of differences in accuracy amongst them leading to a lack of consensus. Objectives: Study aims to correlate sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of selected 17 standard ECG criteria in the diagnosis of LVH, correlation with echocardiography and myocardial global longitudinal strain (GLS). Demographics: Average age of the 104 hypertensive individuals included in the study was 61.86 years with 43.3% women. 73% of subjects had LVH on echocardiography with mean LVMI 115.97g/m2 and mean RWT 0.5. Results: Groningen criteria (24.70%) and Cornell voltage criteria (20.98%) had the best sensitivity for LVH detection. Groningen criteria was defined as QV2+R1+RV5+RV6+SV2+SV4+SV5+SV6 >= 49.5 mm in women and R1+RV5+SII+ SV2+SV6 x QRS duration >= 4500mm msec in men. Sensitivity for other criteria were lesser; Peguero Lo presti(PL) 13.58%, Sokolow Lyon index(SL) 11.11% and Cornell voltage product (CVP) 6.17%. Specificity and Positive predictive value (PPV) with Groningen criteria were 90% and 95.6% and with Cornell voltage criteria 100% and 100% respectively. Best sensitivity results were on combining all 17 ECG LVH criteria (39.5%). Addition of Groningen criteria improved the sensitivity of SL+CV+PL from 28.39% to 38.3%. Combination of the commonly used CV+SL+PL criteria yielded better sensitivity (28.39%) as compared to CV (20.98%) alone. Subjects with mild LVH on echo had an average GLS of -15.46+/-2.4% in 75%, subjects with moderate LVH had an average GLS of -14.23+/-2.8% in 71.4% and subjects with severe LVH had an average GLS of -12.6+/-4.9% in 80%. Conclusion: Irrespective of the voltage criteria used, singular or in combination, sensitivity to diagnose LVH proven on echocardiography is low. Novel Groningen criteria was more sensitive than the previously established standard ECG LVH criteria and had the highest association amongst all in patients with reduction in average GLS. Combination of four criteria SL+CV+PL+Groningen had the best sensitivity (38.3%) which improved only by 1.2% if all 17 criteria were combined.

STUDY OF ECG PARAMETERS FOR THE DIAGNOSIS OF LEFT VENTRICULAR HYPERTROPHY IN GERIATRICS PATIENTS

AIMS AND OBJECTIVES: 1. To correlate the relationship of ECG and Echocardiography for the diagnosis of left ventricular hypertrophy 2. To nd out sensitivity and specicity of various electrocardiographic criteria. MATERIALS AND METHODS: A hospital based cross sectional study, conducted in Anantapur Government Hospital over a time period of November 2021 to June 2022. A total of 100 cases were studied. Relevant history and blood pressure readings were taken . All patients underwent 12 lead Electocardiogram and echocardiogram. Eight ECG criteria were compared with echocardiogram for diagnosis of left ventricular hypertrophy. RESULTS: Out of 100 patients, 54 (54%) had LVH on Echocardiogram. Sokolow Lyon criteria showed sensitivity of 77.78%, specicity of 60.87%, PPV of 70%, NPV of 70% and accuracy of 70%. Comparison of Combined or either one of Sokolow Lyon and Romhilt Estes point score system on ECG with Echo for LVH showed sensitivity of 100%, specicity 60.87%, PPV 75%, NPV 100% and diagnostic accuracy of 82%. Combination or either one of the Sokolow Lyon and Romhilt Estes point score system CONCLUSION: for ECG diagnosis of LVH has a very high sensitivity. Absence of either any of these criteria can be very well used to rule out the diagnosis LVH in resource limited settings.

Comparison of electrocardiographic versus echocardiographic detection of left ventricular mass changes over time and evaluation of new onset left ventricular hypertrophy.

We assessed the value of 3 electrocardiographic (EKG) voltage criteria in detecting variations of left ventricular mass (LVM) over time, taking echocardiographic (ECHO) LVM as reference, in the Pressioni Arteriose Monitorate E Loro Associazioni study. In 927 subjects (age 47±13 years on entry, 49.9% men) an ECHO evaluation of LVM and EKG suitable for measurement of EKG-LVH criteria (Sokolow-Lyon voltage, Cornell voltage and R-wave voltage in aVL) were available at baseline and at a 2nd evaluation performed 10 years later. Δ (delta) LVM, Δ LVMI, and Δ EKG parameters values were calculated from 2nd evaluation to baseline. The sensitivity of the EKG criteria in the diagnosis of LVH, poor at baseline, becomes even worse after 10 years, reaching very low values. Only the sensitivity of R-wave amplitude exhibited slight increase over time but with unsatisfactory absolute values. Despite the prevalence of ECHO-LVH at the 2nd evaluation was threefold increased compared to baseline (29.3% and 33.7% for LVM indexed to BSA and height2.7 , respectively), the prevalence of EKG-LVH was unchanged when evaluated by Sokolow-Lyon criteria, significantly reduced when assessed by Cornell voltage index, while significantly increased using R-wave voltage in aVL criteria. Despite an ECHO-LVM increase over the time, mean EKG changes were of opposite sign, except for R-wave amplitude in aVL. Our study highlights the discrepancy between ECHO and EKG in monitoring LVM changes over the time, especially for Sokolow-Lyon and Cornell voltage. Thus, EKG is an unsuitable method for the longitudinal evaluation of LVM variations.

Performance of the Peguero-Lo Presti Index in Diagnosis of Left Ventricular Hypertrophy at CIMAK Hospital Center in North Kivu, Democratic Republic of the Congo

Background and Objective: Despite the costs generated in the diagnosis of cardiac pathologies by the use of ultrasound, the ECG indices have demonstrated a high performance in the studies of developed countries in the diagnosis of these pathologies, but the data of these in sub-Saharan Africa are limited. The objective of this study is to evaluate the performance of the Peguero-Lo Presti index in the diagnosis of LVH among Congolese in order to make it a means of LVH diagnosis in an under-equipped environment. Methods: Cross-sectional and analytical study including 413 patients followed and hospitalized at the CIMAK Hospital Center during the period from February 2019 to June 2021. Sociodemographic parameters, history, biology, ultrasound and ECG parameters were studied. The performance of the Peguero-Lo Presti Index was validated by the Youden Index reinforced by the Area under the ROC curve. Results: Of the 413 patients admitted to the study, 69.5% were men versus 30.5% women, i.e. a sex ratio of 2M/1F; the mean age of the patients was 51.1 ± 11.6 years. The frequency of LVH found by echocardiography was 55.9%, it was 50.8% using the Peguero-Lo Presti index, 22% and 10.2% using the Peguero-Lo Presti index, respectively. Sokolow-Lyon and Cornell (p 0.001). The Peguero-Lo Presti curve is higher than the Sokolow-Lyon and Cornell curves. The area under the curve was 0.80 for Peguero-Lo Presti, 0.73 for Sokolow-Lyon and 0.66 for cornell. Conclusion: The newly proposed Peguero-Lo Presti index provides high sensitivity and specificity for the diagnosis of LVH in black Africans as also reported in the European and American population.

The Correlation of Fibroblast Growth Factor 23 with Cardiac Remodeling in Essential Hypertension with Normal Renal Function

Background: Fibroblast growth factor 23 (FGF23), a glycoprotein-regulating calcium and phosphorus homeostasis, has been linked to cardiovascular diseases. We aimed to evaluate the correlation of FGF23 levels and cardiac remodeling (left atrial [LA] enlargement and left ventricular hypertrophy [LVH]) in essential hypertension (EH) with normal renal function and explore the diagnostic values of FGF23 and B-type natriuretic peptide (BNP) in cardiac remodeling. Methods and Results: We enrolled 40 healthy control subjects (group I) and 146 EH patients (group II). Plasma FGF23 concentration was measured in all subjects. In this study, FGF23 level was significantly higher in group II (660.77 [446.26, 1,001.72]) pg/mL compared with the controls (73.23 [52.92, 103.69]) pg/mL (p < 0.001). Logistic regression analysis revealed that FGF23 was independently correlated to LVH and LA enlargement. Receiver operating characteristic (ROC) curve indicated FGF23 had an optimal cutoff of 834.63 pg/mL for LVH (area under ROC curve [AUC], 0.913; 95% CI: 0.863–0.963) and 497.06 pg/mL for LA enlargement (AUC, 0.694; 95% CI: 0.612–0.768). The DeLong test was performed to compare AUCs of FGF23 and BNP, and the AUC of FGF23 (0.913) was statistically higher compared to AUC of BNP (0.661) (DeLong test: p < 0.001) in the diagnosis of LVH. Conclusion: Plasma FGF23 level elevated in EH, increased with the progress of cardiac remodeling, and was independently related to LVH and LA enlargement. The diagnostic value of FGF23 in cardiac remodeling, especially for LVH, was superior to BNP.

Using deep learning method to identify left ventricular hypertrophy on echocardiography

BackgroundLeft ventricular hypertrophy (LVH) is an independent prognostic factor for cardiovascular events and it can be detected by echocardiography in the early stage. In this study, we aim to develop a semi-automatic diagnostic network based on deep learning algorithms to detect LVH.MethodsWe retrospectively collected 1610 transthoracic echocardiograms, included 724 patients [189 hypertensive heart disease (HHD), 218 hypertrophic cardiomyopathy (HCM), and 58 cardiac amyloidosis (CA), along with 259 controls]. The diagnosis of LVH was defined by two experienced clinicians. For the deep learning architecture, we introduced ResNet and U-net++ to complete classification and segmentation tasks respectively. The models were trained and validated independently. Then, we connected the best-performing models to form the final framework and tested its capabilities.ResultsIn terms of individual networks, the view classification model produced AUC = 1.0. The AUC of the LVH detection model was 0.98 (95% CI 0.94–0.99), with corresponding sensitivity and specificity of 94.0% (95% CI 85.3–98.7%) and 91.6% (95% CI 84.6–96.1%) respectively. For etiology identification, the independent model yielded good results with AUC = 0.90 (95% CI 0.82–0.95) for HCM, AUC = 0.94 (95% CI 0.88–0.98) for CA, and AUC = 0.88 (95% CI 0.80–0.93) for HHD. Finally, our final integrated framework automatically classified four conditions (Normal, HCM, CA, and HHD), which achieved an average of AUC 0.91, with an average sensitivity and specificity of 83.7% and 90.0%.ConclusionDeep learning architecture has the ability to detect LVH and even distinguish the latent etiology of LVH.

Differential diagnosis of left ventricular hypertrophy with cardiac magnetic resonance imaging texture feature analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background Hypertrophic cardiomyopathy (HCM), hypertensive cardiomyopathy (HTCM), and cardiac amyloidosis (CA) are characterized by left ventricular (LV) hypertrophy. CMR with late gadolinium enhancement is used in the differential diagnosis. Radiomics aims to extract features from medical images and quantify their patterns to produce quantitative biomarkers. Our aim was to develop radiomics-derived biomarkers capable of differentiating between HCM, HTCM, CA and healthy controls using CMR cine images. Methods We included 103 patients (42 HCM, 51 HTCM, 10 CA; 31 females, age 65.0 ± 12.8 years) and 50 healthy subjects (29 females, age 52.5 ± 18.0 years). The study was done on a 1.5 T CMR scanner (Sonata; Siemens, Erlangen, Germany) and all the subjects underwent a conventional protocol including cine sequences acquired in the 2-, 4- and 3-chamber views as well as in a short axis stack. The most basal slice of the short axis stack immediately distal to the LV outflow tract was used for texture feature analysis and regions of interest (ROI) were defined by segmenting the LV myocardium and dividing it into 6 segments. For image analysis a radiomic approach was used. Five different quantizations were obtained in order to find the optimal one and 43 texture features were extracted by quantization and segment. Feature selection (FS) methods were studied to see the optimal number of textures, and 4 predictive models were evaluated including k-Nearest Neighbour (KNN) and Support Vector Machine with a linear kernel (SVML) models. Performance of each model was evaluated with the area under the ROC curve (AUC). Results The AUCs of each of the models for the different texture features were analysed, from 1 to 43, according to the ranking obtained and for 5 different number of grey levels. The maximum average AUC, 1.0, was obtained with KNN model trained to classify CA and control subjects. More interestingly, 0.89 average AUC was achieved with SVML model and 1 single feature for HCM vs HTCM vs CA study. Table 1 shows the best average AUCs (mean ± SD) obtained for each study, number of subjects (N), number of grey levels used in each case, number of optimal features and the classification model. Conclusions Texture analysis allows for the correct differential diagnosis of LVH. Best results (AUC of 89%), were achieved using the SVML model in septal segments. Texture feature analysis applied to CMR cine sequences is a promising advance that might allow for the use of contrast-free protocols for the differential diagnosis of LVH.

MO758DIAGNOSTIC ACCURACY OF ELECTROCARDIOGRAPHIC METHODS OF ESTIMATION OF LEFT VENTRICULAR HYPERTROPHY IN A HAEMODIALYSIS POPULATION

Abstract Background and Aims Left ventricular hypertrophy is common in end stage renal disease (ESRD) and haemodialysis. Its association with cardiovascular outcomes has been demonstrated. In this study we evaluated the diagnostic accuracy of electrocardiographic methods of calculating LVH compared to Real Time 3- Dimensional Echocardiogram (RT3DE) which we used as a surrogate gold standard test. Method This study was performed as a post-hoc analysis of a sub-group of patients enrolled into the Salford Kidney Study (SKS). Patients included into this analysis are from the sub-group of SKS previously known as the CRISIS-HD cohort. All adult haemodialysis patients at Salford Royal NHS Foundation Trust, UK or one of its satellite units are considered for inclusion. In this study we examined the sensitivity, specificity, positive predictive value and negative predictive value of Sokolow – Lyon and Romhilt –Estes methods in comparison to RT3DE. Results The final sample comprised 44 patients. The vast majority were Caucasian (39 patients). The mean age of the patients was 62 ± 13 years and mean time on dialysis 5.1 ± 2.9 years. The sensitivity of both ECG methods for diagnosis of LVH was very low. This was the case for the whole sample and also for individual groups. Romhilt – Estes was marginally better than Sokolow – Lyon and that was especially the case for male patients. Conclusion Our study shows that ECG methods for assessment of LVH that rely on voltage criteria have very low sensitivity and unreliable specificity compared to RT3DE and also conventional M –Mode echocardiography. As a result, they could not be reliably used as a quick and inexpensive method of LVH estimation in clinical practice in the case of haemodialysis patients.

A STUDY OF EFFICACY OF THE CLASSIC ECG CRITERIA TO DIAGNOSE LEFT VENTRICULAR HYPERTROPHY IN HYPERTENSIVE SUBJECTS AND EVALUATION OF A NEW SCORE

This observational cross-sectional Study was done in the Institute of Cardiovascular Sciences in R. G. Kar Medical College and Hospital from February, 2015 to December 2016. Atotal of 220 hypertensive patients were included through simple random sample selection. Patients who full the inclusion and exclusion criteria were enrolled for the study after getting written informed consent. This study was carried out using the echocardiogram as the gold standard for the diagnosis of LVH. The new score proposed here, of which cutoff for the diagnosis of LVH was arbitrarily set at 2800mm-ms, is easily applicable in clinical practice and presented the best correlation with the LVMI, when compared to some classic electrocardiographic criteria.

Clinical variables improve efficacy of ECG scores to diagnose the left ventricular hypertrophy in general population

Abstract Left ventricular hypertrophy (LVH) is an important risk factor of various cardiovascular (CV) diseases and sudden death. Electrocardiography (ECG) is commonly used to detect LVH, but it has poor sensitivity, especially in high cardiovascular risk patients. Although echocardiography (ECHO) is a better, it is less available, and more expensive. Aim: To improve ECG scores to diagnose LVH in a general population. Methods The study was conducted in 2017–2019 in a representative sample of area residents. 717 volunteers randomly chosen from the local population were examined. Due to incomplete data, QRS complex duration ≥120ms, fascicular blocks, bundle branch blocks, paced rhythm, 216 people were excluded. Physical examination, ECG, ECHO and laboratory assessment were performed. In ECG LVH defined as &amp;gt;28mm for men, &amp;gt;20mm for women using Cornell index; &amp;gt;17mm for both sexes using Lewis index. In ECHO LV mass was calculated using the Devereux Formula and indexed by body surface area (left ventricular mass index – LVMI). The LVH was defined as LVMI ≥115 g/m2 for man and ≥95 g/m2 for women. Cardiovascular risk was calculated based on the ESC SCORE and additional risk categories published in the latest ESC guidelines. We analyzed 4 models to predict the probability of LVH at ECHO: Model 1: Cornell index; Model 2: Lewis index; Model 3: Cornel index + clinical parameters (age, sex, BMI, office BPs, QRS time, hs-TnT, and HbA1c); Model 4: Lewis index + clinical parameters (age, sex, BMI, office BPs, QRS time, hs-TnT, and HbA1c). Associations between LVH and clinical and biochemical variables were earlier analyzed using multiple linear regression models, these parameters were independently associated with LVH. Results A total of 501 patients were included. The average age of patients was 49.0±15.35 years, and 203 probants (40.5%) were male. We developed a novel score to assess the probability of LVH at ECHO in general population based on nine items (age, sex, body mass index, office BPs, Cornell index or Lewis index, QRS time, hs-TnT, and HbA1c). Additional clinical parameters improved sensitivity of Cornell index up to 86.0% (AUC:0.8011; 95% CI:0.748–0.854) from 64.9% (AUC:0.6450; 95% CI:0.573–0.716) in general population, to 92.9% (AUC:0.8423; 95% CI:0.760–0.924) from 64.3% (AUC:0.6481; 95% CI:0.518–0.779) in low CV risk patients, to 69.2% (AUC:0.6767; 95% CI:0.544–0.809) from 38.5% (AUC:0.5284; 95% CI:0.352–0.705) in moderate CV risk, and to 73.3% (AUC:0.7151; 95% CI: 0.609–0.821) of Lewis index from 50.0% (AUC: 0.5630; 95% CI:0.448–0.678) in high and very-high CV risk class. Conclusions Addition of clinical parameters to ECG indices in the diagnosis of LVH markedly improves their diagnostic efficacy both in general population and in higher risk groups. The new score may be useful in guiding the appropriateness of ECHO study in general population, and especially in moderate and high CV risk patients, who are not always aware of the increased CV risk. ROC curves for recognize LVH. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Medical University of Bialystok for Bialystok PLUS study

A Population‐wide study of electrocardiographic (ECG) norms and the effect of demographic and anthropometric factors on selected ECG characteristics in young, Southeast Asian males—results from the Singapore Armed Forces ECG (SAFE) study

Routine use of pre-participation electrocardiograms (ECGs) has been used by the Singapore Armed Forces, targeting early detection of significant cardiac diseases. We aim to describe the impact of demographic and anthropometric factors on ECG variables and establish a set of electrocardiographic reference ranges specific to a young male multiethnic Southeast Asian cohort. Between November 1, 2009, and December 31, 2014, 144,346 young male conscripts underwent pre-participation screening that included a 12-lead ECG, demographic and anthropometric measurements. The Chinese population had the longest PR interval (146.7±19.7 vs. 145.21±19.2 in Malays vs. 141.2±18.8ms in Indians), QRS duration (94.5±9.8 vs. 92.6±9.7 in Malays vs. 92.5±9.4ms in Indians) and QTcB interval (408.3±21.3 vs. 403.5±21.6 in Malays vs. 401.2±21.4ms in Indians) (all p<0.001). Body mass index (BMI) >25kg/m2 and body fat >25% were independently associated with lower prevalence of increased QRS voltage on ECG. Systolic blood pressure of >140mmHg or diastolic blood pressure of >90mmHg independently increased the prevalence of increased QRS voltage on ECG. Electrocardiographic parameters vary across different ethnicities and in comparison with international norms. In our population, diagnosis of increased QRS voltage by ECG is less prevalent with obesity and increased body fat. Further analysis of gold standard measurements for the diagnosis of LVH in our population is ongoing, to improve the accuracy of the ECG screening process.

Sensitivity and Specificity of Electrocardiographic Criteria for Left Ventricular Hypertrophy in Children with Rheumatic Heart Disease

Electrocardiographic criteria for left ventricular hypertrophy (LVH) were examined in 84 unselected pediatric patients with rheumatic heart disease. There were 47 male and 37 female patients, ranging in age from 6 to 19 years. Electrocardiographic LVH was detected in 41 patients (48.8%), i.e. in 55.3% (26/47) of boys and in 36.6% (15/41) of girls. Echocardiographically determined LVH was present in 42 cases (50%) if left ventricular mass (LVM) was indexed for height, or 47 cases (56%) if LVM was indexed for body surface area (BSA). The overall sensitivity of height-indexed electrocardiographic diagnosis of LVH was 71.4% (95% confidence interval = 57.7% to 85.1%), while its sensitivity was 73.8% (95% confidence interval = 60.0% to 87.0%). For BSA-indexed echocardiographic LVH, the sensitivity was 68.1% (95% confidence interval = 54.8 to 81.4%) and the specificity was 75.7% (95% confidence interval = 61.9% to 89.5%). When sex-adjustment was examined, there was no increase of sensitivity of electrocardiographic LVH. Sensitivity of the electrocardiogram for LVH increased when age-adjustment was examined with 13 years of age as a cut-off point, both for height-indexed and BSA-indexed echocardiographic LVH. Reasons for the difference between these findings and the findings in adult patients (remarkably low sensitivity and very high specificity of ECG LVH) were discussed. Electrocardiogram was a moderate diagnostic modality in the detection of LVH in our pediatric patients with rheumatic rheumatic heart disease. Sex did not influence the sensitivity of ECG LVH, but older age group tended to increase its sensitivity.

Left Ventricular Hypertrophy dan Fungsi Ginjal pada Penderita Hipertensi

Introduction: Chronic hypertension can cause complication such as left ventricular &lt;br /&gt;hypertrophy (LVH). LVH can lead renal artery vasoconstriction, impaire blood perfusion &lt;br /&gt;to glomerulus and change glomerulus filtration coeficient. The aim of this study was to&lt;br /&gt;compare kidney function between hypertensive patient with LVH and without LVH&lt;br /&gt;Methods: This was a case control study that conducted at Dr. Moewardi General&lt;br /&gt;Hospital Surakarta. All subjects has been diagnosed as hypertension more than 5 years.&lt;br /&gt;The diagnosis of LVH was based on electrocardiography (ECG) result. Kidney function&lt;br /&gt;was assessed based on serum ureum, creatinin, and uric acid levels.&lt;br /&gt;Results: The subject of this study was 26 hypertension patients with LVH and 13&lt;br /&gt;hypertension patients without LVH. Serum ureum level in patients with LVH was higher&lt;br /&gt;than hypertension patients without LVH(24.92 ± 7.99 Vs 32.33±9.91, p= 0.004). Serum&lt;br /&gt;uric acid level in hypertension patients with LVH was higher compare to hypertension&lt;br /&gt;patients without LVH as well (5.26 ± 1.15 Vs 6.98 ± 1.83, p= 0.029). Whereas serum&lt;br /&gt;creatinine levels were not significantly different between two groups of subjects. &lt;br /&gt;Sulastomo et.al., Left Ventricular Hypertrophy dan Fungsi Ginjal pada Penderita Hipertensi &lt;br /&gt;Conclusion: : Serum ureum and uric acid levels in hypertensive subjects with LVH are&lt;br /&gt;higher than subjects without LVH. There is no difference between serum creatinin level in&lt;br /&gt;hypertensive subject with LVH and without LVH.&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;

Assessment of Peguero Lo-Presti criteria for electrocardiographic diagnosis of LVH in Indian subjects

Background and objectivesThe sensitivity of ECG to diagnose LVH is low. Peguero Lo-Presti have proposed new ECG criteria for LVH to improve the sensitivity of ECG while maintaining the high specificity when compared to older well-established criterion like Cornell voltage and Sokolow Lyon. The objective of this study was to evaluate Peguero Lo-Presti criteria in the diagnosis of LVH in patients with hypertension. Methodology400 consecutive patients with hypertension who have visited the cardiology OPD and have undergone ECG and 2D echocardiography were included in the study. Patients with valvular regurgitation (Grade II or higher), myocardial infarction, valvular stenosis, LV dysfunction, pericardial disease, COPD, bundle branch blocks, atrial fibrillation or flutter were excluded from the study. ResultsLVH was diagnosed in 192 (48%) of the patients by 2D echocardiography. Of the 192 patients, 104 patients had LVH based on Peguero Lo-Presti criteria with a sensitivity of 54.17%. Cornell Voltage criteria was positive in 76 out of 192 patients with a sensitivity of 39.58% and Sokolow-Lyon criteria was positive in 56 out of 192 with a sensitivity of 29.17%. The Peguero Lo-Presti ECG criteria had a higher sensitivity (54.17%) and specificity (91.35%) in the diagnosis of LVH by ECG. ConclusionPeguero Lo-Presti criteria to diagnose LVH has higher sensitivity and specificity compared to Sokolow-Lyon and Cornell voltage criteria.

The importance of a shared definition of left ventricular hypertrophy: The case of obese women

BackgroundLeft ventricular hypertrophy (LVH) is a risk factor for all-cause mortality. Left ventricular (LV) mass is usually indexed for normalizing the value to the patients phenotype and a correction by body surface area (BSA) is widely utilized being the only approved one according to the last echocardiography guidelines. However indexing LV mass by BSA may cause an underestimation of LVH prevalence in obese subjects and many authors have utilized in the obese subset of patients a correction by height2.7. The aim of our study was to quantify the number of obese patients who, despite having an increased LV mass, fall in the range of normality because they do not reach the LVH cutoff according to the new guidelines. MethodsWe reviewed the echocardiograms of 384 white women free from cardiovascular disease. Ninety-six patients (25%) were obese: among them 42 had mild obesity and 54 had moderate or severe obesity. ResultsIn the obese group, the prevalence of LVH using the absolute LV mass value was similar to the one obtained with the height2.7 correction while a significant smaller number of patients had LVH according to BSA correction. Our study confirms that the method used for correcting LV mass significantly influences the diagnosis of LVH in a non-selected female population: using body surface area underestimates the prevalence of LVH as compared to allometric measures in the obese subset of patients. ConclusionWe recommend that height2.7 be used for LV mass correction in obese patients.

1 Can multilayer speckle imaging help in the aetiological diagnosis of LVH?

1 Can multilayer speckle imaging help in the aetiological diagnosis of LVH?

Relevance to Home Blood Pressure Monitoring Protocol of Blood Pressure Measurements Taken Before First-Morning Micturition and in the Afternoon

BackgroundThe importance of measuring blood pressure before morning micturition and in the afternoon, while working, is yet to be established in relation to the accuracy of home blood pressure monitoring (HBPM). Objective: To compare two HBPM protocols, considering 24-hour ambulatory blood pressure monitoring (wakefulness ABPM) as gold-standard and measurements taken before morning micturition (BM) and in the afternoon (AM), for the best diagnosis of systemic arterial hypertension (SAH), and their association with prognostic markers.MethodsAfter undergoing 24-hour wakefulness ABPM, 158 participants (84 women) were randomized for 3- or 5-day HBPM. Two variations of the 3-day protocol were considered: with measurements taken before morning micturition and in the afternoon (BM+AM); and with post-morning-micturition and evening measurements (PM+EM). All patients underwent echocardiography (for left ventricular hypertrophy - LVH) and urinary albumin measurement (for microalbuminuria - MAU).ResultKappa statistic for the diagnosis of SAH between wakefulness-ABPM and standard 3-day HBPM, 3-day HBPM (BM+AM) and (PM+EM), and 5-day HBPM were 0.660, 0.638, 0.348 and 0.387, respectively. The values of sensitivity of (BM+AM) versus (PM+EM) were 82.6% × 71%, respectively, and of specificity, 84.8% × 74%, respectively. The positive and negative predictive values were 69.1% × 40% and 92.2% × 91.2%, respectively. The comparisons of intraclass correlations for the diagnosis of LVH and MAU between (BM+AM) and (PM+EM) were 0.782 × 0.474 and 0.511 × 0.276, respectively.Conclusions The 3 day-HBPM protocol including measurements taken before morning micturition and during work in the afternoon showed the best agreement with SAH diagnosis and the best association with prognostic markers.

What is the role of cardiac MRI in the diagnosis of left ventricular non-compaction?

Background The prevalence of left ventricular non-compaction is not well established. Using 2-D echocardiography, less than 1% of patients are diagnosed with this entity. Using cardiac MRI, approximately 3% of patients have evidence of LV non-compaction. This variance may be related to the difference in spatial resolution between these 2 imaging techniques. Using a large institutional cardiac imaging database, 2-D echo and cardiac MRI results were compared in patients with LV non-compaction. Methods Of 1,255 patients in our cardiac imaging database, 38 patients (3%) with a diagnosis of LV non-compaction were identified. Twenty-two of these 38 patients had undergone both 2-D echo and cardiac MRI exams. The reported diagnoses with each imaging modality were tabulated, along with measurements of left ventricular antero-septal and infero-posterior wall thickness for both modalities. The 2-D echo and cardiac MRI wall thickness dimensions were statistically compared using a paired sample t-test. Results All 38 patients had a diagnosis of LV non-compaction on cardiac MRI, using criteria of non-compacted/compacted myocardium > 2.5 to 1.0 and deep LV trabeculations. None of the 22 patients with both 2-D echo and cardiac MRI exams had a diagnosis of LV non-compaction on their 2-D echo study. However, 15 of 22 patients (68%) had a diagnosis of LVH on their 2-D echo study, while only 3 had LVH on their cardiac MRI study. The mean ASWT on 2-D echo was 1.38 cm, while the mean ASWT on cMRI was 1.16 cm (p<0.005). The mean IPWT on 2-D echo was 1.31 cm, while the IPWT on cMRI was only 0.89 cm (p<0.001). Conclusions These data suggest that LV non-compaction, identifiable on cardiac MRI, is frequently diagnosed as LVH on 2-D echo. This discrepancy appears to be explained by the statistically significant difference in both antero-septal and infero-posterior LV wall thickness measurements between the 2 imaging modalities. It is suspected that this difference is related to the inferior spatial resolution of 2-D echo relative to cMRI. On the basis of these data, patients with LVH on 2-D echo should be considered for a cardiac MRI exam to determine if the increased LV wall thickness is truly LVH or an undiagnosed LV non-compaction cardiomyopathy.