ECG Criteria For Left Ventricular Hypertrophy Research Articles

Searching for the Best Machine Learning Algorithm for the Detection of Left Ventricular Hypertrophy from the ECG: A Review.

Background: Left ventricular hypertrophy (LVH) is a powerful predictor of future cardiovascular events. Objectives: The objectives of this study were to conduct a systematic review of machine learning (ML) algorithms for the identification of LVH and compare them with respect to the classical features of test sensitivity, specificity, accuracy, ROC and the traditional ECG criteria for LVH. Methods: A search string was constructed with the operators "left ventricular hypertrophy, electrocardiogram" AND machine learning; then, Medline and PubMed were systematically searched. Results: There were 14 studies that examined the detection of LVH utilizing the ECG and utilized at least one ML approach. ML approaches encompassed support vector machines, logistic regression, Random Forest, GLMNet, Gradient Boosting Machine, XGBoost, AdaBoost, ensemble neural networks, convolutional neural networks, deep neural networks and a back-propagation neural network. Sensitivity ranged from 0.29 to 0.966 and specificity ranged from 0.53 to 0.99. A comparison with the classical ECG criteria for LVH was performed in nine studies. ML algorithms were universally more sensitive than the Cornell voltage, Cornell product, Sokolow-Lyons or Romhilt-Estes criteria. However, none of the ML algorithms had meaningfully better specificity, and four were worse. Many of the ML algorithms included a large number of clinical (age, sex, height, weight), laboratory and detailed ECG waveform data (P, QRS and T wave), making them difficult to utilize in a clinical screening situation. Conclusions: There are over a dozen different ML algorithms for the detection of LVH on a 12-lead ECG that use various ECG signal analyses and/or the inclusion of clinical and laboratory variables. Most improved in terms of sensitivity, but most also failed to outperform specificity compared to the classic ECG criteria. ML algorithms should be compared or tested on the same (standard) database.

Magnetic Resonance for Differential Diagnosis of Left Ventricular Hypertrophy: Diagnostic and Prognostic Implications.

Background: Left ventricular hypertrophy (LVH) may be due to different causes, ranging from benign secondary forms to severe cardiomyopathies. Transthoracic Echocardiography (TTE) and ECG are the first-level examinations for LVH diagnosis. Cardiac magnetic resonance (CMR) accurately defines LVH type, extent and severity. Objectives: to evaluate the diagnostic and prognostic role of CMR in patients with TTE and/or ECG evidence of LVH. Methods: We performed CMR in 300 consecutive patients with echocardiographic and/or ECG signs of LVH. Results: Overall, 275 patients had TTE evidence of LVH, with initial suspicion of hypertrophic cardiomyopathy (HCM) in 132 (44%), cardiac amyloidosis in 41 (14%), hypertensive LVH in 48 (16%), aortic stenosis in 4 (1%), and undetermined LVH in 50 (16%). The initial echocardiographic diagnostic suspicion of LVH was confirmed in 172 patients (57.3%) and changed in 128 patients (42.7%, p < 0.0001): the diagnosis of HCM increased from 44% to 71% of patients; hypertensive and undetermined LVH decreased significantly (respectively to 4% and 5%). CMR allowed for a diagnosis in 41 out of 50 (82%) patients with undetermined LVH at TTE. CMR also identified HCM in 17 out of 25 patients with apparently normal echocardiography but with ECG criteria for LVH. Finally, the reclassification of the diagnosis by CMR was associated with a change in survival risk of patients: after CMR reclassification, no events occurred in patients with undetermined or hypertensive LVH. Conclusions: CMR changed echocardiographic suspicion in almost half of patients with LVH. In the subgroup of patients with abnormal ECG, CMR identified LVH (particularly HCM) in 80% of patients. This study highlights the indication of CMR to better characterize the type, extent and severity of LVH detected at echocardiography and suspected with ECG.

The efficiency of two-level electrovectorcardiographic diagnostics of left ventricular hypertrophy in the medical examination of urban and rural population

Background. The incidence of arterial hypertension continues to grow. By 2025 the number of patients will increase to 1.5 billion that makes it necessary to develop and implement effective approaches in the diagnosis and treatment of hypertension in practical health care.&#x0D; Aim. Evaluate the effectiveness of two-level diagnostics of left ventricular hypertrophy (LVH).&#x0D; Materials and methods. The distance of the first level of LVH diagnostics in outpatient departments with a territorial is more than 20 km. It was performed by remote electrocardiography, including medical examination of the population. Automatic conclusion of the devices was sent to the personal office of the functional diagnostics doctor. At the second level, the electrocardiograph software was used to convert ECG-12 into a vectorcardiogram (VKG) to clarify LVH. The ECG reports were returned to the device of the doctor/paramedic for further work with the patient. When using scalar ECG criteria for LVH, the most sensitive index was the SokolovLyon index 24.2% of cases, then the Cornell product 19.8% of cases. In the second level of ECG diagnostics, the sensitivity of the method in detecting LVH increased more than 3 times: in terms of the maximum loop vector modulus (M QRS 1.8 mV), 72%, the sensitivity of the total index Rx+Sz (2.7 mV) was 58% of cases, the deviation of the spatial angle QRS-T90 was 42.5%, the spatial area of the loop QRS (S QRSxyz 2.7 mV2), the area of the loop QRS in the horizontal plane (S QRSxz2.2 mV2) 41.5%, the orientation angle of the maximum loop vector t in the horizontal plane (angle Txz70) was detected in 38% of patients. These indicators were found with the same frequency in both groups of examined individuals.&#x0D; Conclusion. The use of remote two-level ECG and ECG diagnostics allowed to increase the detection of LVH in rural and urban populations by 3 times.

COMPARING THE DISCRIMINATIVE ABILITY OF DIFFERENT ELECTROGRAPHIC CRITERIA FOR LEFT VENTRICULAR HYPERTROPHY IN PREDICTING CARDIOVASCULAR EVENTS IN HYPERTENSIVE PATIENTS

Abstract Objective: Several ECG criteria are used clinically to define Left Ventricular Hypertrophy (LVH), but there is no consensus on which of these criteria is better at predicting cardiovascular (CV) events in hypertensive patients. In this post-hoc analysis, our objective was to compare the discriminative ability and strength of association of different LVH criteria to predict the risk of CV-morbidity and mortality. Design and method: We used the database of the Anglo-Scandinavian Cardiovascular Outcome Trial Our primary outcome was composite of fatal and non-fatal CV event including: coronary heart disease, stroke and coronary re-vascularisation. We developed several cox regression models, separately for each LVH criterion (Modified Sokolov, Cornell, Framingham, Strain Pattern, Cornell-Strain, Cornell-Product), after adjusting for a-priori confounders (age, sex, smoking status, diabetes, pulse pressure, chronic kidney disease stage 3) and other confounders found using stepwise selection (number of anti-hypertensives, previous vascular disease, metabolic syndrome, atrial fibrillation). We compared discriminative ability using c-statistic, goodness of fit of the model using Bayesian information criterion (BIC), hazard ratios (HR) and z-statistics for strength of association of each one of these LVH criteria in respective models. Results: 9.7% to 17.2% of 17959 hypertensive patients had LVH at baseline as defined by one or more LVH criterion (see Fig. 1). During a median follow up of 5.6 Years (IQR 5.2–6.1) there were 2736 CV events. Figure 1 shows that, whilst c-statistics and accuracy of most criteria are similar, strain pattern and the Cornell strain are better in improving the prediction models and with a higher strength of association with the CV-outcomes (HR 1.52 95% CI: 1.35 - 1.71, Z-statistic 6.88 and HR 1.37 95% CI: 1.226 - 1.519, Z-statistic 5.70, respectively). Both criteria had excellent BIC too. Conclusions: In hypertensive patients, compared to other ECG criteria of LVH, strain pattern and Cornell-strain index are stronger and better predictor of the risk of CV morbidity and mortality.

Elektrokardiografia w diagnostyce przerostu mięśnia lewej komory u pacjentów ze schyłkową niewydolnością nerek leczonych powtarzanymi zabiegami hemodializ

Introduction. Left ventricular hypertrophy (LVH) is one of the most common cardiovascular risk factors in patients under- going haemodialysis (HD). Although standard ECG can help to identify patients at greater risk of LVH, its prognostic value in haemodialysed patients is uncertain. This study aimed to evaluate currently used ECG criteria for LVH in patients on renal replacement therapy. Material and methods. A group of 90 patients, who were undergoing qualification to renal transplantation, were included in the study. Every patient underwent 12-lead ECG and transthoracic echocardiography. Patients with any conduction disorders were excluded from the study. Finally, the study group consisted of 76 patients (21 women, mean age 53.1 ± 14.4 years). Results. LVH was diagnosed by echocardiography in 39 patients (51%, 27 men and 12 women). Only three out of six tested criteria showed satisfactory performance for LVH diagnosis in HD patients: the sum of S V3 and R aVL > 28 mm in men, and > 20 mm in women (area under curve [AUC] 68%, 95% confidence interval [CI] 56–80); the sum of S V1 and R V5 or V6 > 35 mm (AUC 63%, 95%CI 50–76); and the sum of SV2 and RV5 or V6 > 45 mm (AUC 63%; 95%CI 50–75). Conclusions. The present ECG diagnostic criteria for LVH are of very limited value in patients undergoing HD. Further studies should be performed to establish new ECG criteria for this group of patients. In the meantime, echocardiography should be recommended as the most precise diagnostic routine test to evaluate HD patients for LVH.

Electrocardiographic criteria for left ventricular hypertrophy in aortic valve stenosis: Correlation with echocardiographic parameters.

Aortic valve stenosis (AS) generates a chronic pressure overload that induces left ventricular hypertrophy (LVH). The aim of this study was to assess the prevalence of the electrocardiographic criteria for LVH in patients with clinically significant AS and to evaluate the relationship between the ECG criteria for LVH and echocardiographic parameters. The clinical data of 95 patients with moderate to severe AS were retrospectively analyzed. Eight ECG criteria for LVH were used and compared to the results of transthoracic echocardiography (TTE). In 59% of patients, at least one of the ECG criteria for LVH was found. These patients had a greater LVMI (142.1±35.6 vs. 124.1±22.5g/m2 , p=0.01) and peak aortic jet velocity (4.2±0.8 vs. 3.8±0.9m/s, p=0.01) along with smaller aortic valve area (0.72±0.28 vs. 0.86±0.22 cm2 , p=0.02) compared to patients with a negative ECG for LVH. The ECG parameters had a low sensitivity (6%-36.9%) with a specificity of up to 100%. The Cornell Voltage criteria had the best sensitivity with a specificity of 63.6% and the highest correlation with the LVMI (r=0.38, p<0.001). All of the ECG parameters correlated positively with the peak aortic jet velocity as well as with the mean aortic gradient. The electrocardiographic criteria for LVH in patients with moderate or severe AS have a poor sensitivity in identifying LVH confirmed by TTE. The values of the selected ECG criteria for LVH correlate weakly with both the TTE indices of LVH and the markers of AS severity.

QRS complex waveform indicators of ventricular activation slowing: Simulation studies

Diffuse or regional activation slowing in ventricular myocardium can result from different cardiac pathologies, such as left ventricular hypertrophy, ischemia or fibrosis. Altered ventricular activation sequence leads to deformations of the activation front and consequently to the changes in the QRS complex. Using a computer model we simulated the effect of slowed ventricular activation on the QRS waveform with a special interest in ECG changes which reproduce the ECG criteria of left ventricular hypertrophy (ECG-LVH). This paper describes results of a set of computer modeling experiments and discusses visual QRS patterns. Slowed ventricular activation in the whole left ventricle resulted in the prolongation of QRS duration, leftward shift of electrical axis, and increase in the QRS amplitude mainly in the precordial leads, having thus their main impact on simulated Sokolow–Lyon index and Cornell voltage. Slowed ventricular activation in the anteroseptal region resulted in a leftward shift of the electrical axis and increased values of ECG-LVH criteria seen in limb leads or in a combination with precordial leads (Gubner criterion, Cornell voltage). Transmural slowing and midwall slowing in two layers in the anteroseptal area led also to the QRS duration prolongation. Changes in QRS complex were more pronounced in the cases of transmural slowing as compared to the left ventricular midwall slowing. Using computer modeling, we showed that slowed ventricular activation is a potent determinant of QRS complex morphology and can mimic ECG patterns that are usually interpreted as the effect of left ventricular hypertrophy, i.e., increased left ventricular mass. These results contribute to understanding the variety of ECG finding documented in patients with LVH, considering not only anatomical enlargement but also the altered electrical properties of hypertrophied myocardium.

Clinical Diagnosis of Electrical Versus Anatomic Left Ventricular Hypertrophy: Prognostic and Therapeutic Implications.

Left ventricular hypertrophy (LVH) can develop in association with chronic arterial hypertension and other cardiovascular disorders and is a well-established risk factor for cardiac arrhythmias, cardiovascular events, and mortality.1 Over 4 decades ago the Framingham Heart Study reported that electrocardiographic evidence of LVH (ECG LVH) was associated with 3- to 4-fold increase in cardiovascular and all-cause mortality, with a disproportionately high risk of sudden cardiac death (SCD).2,3 Subsequently, multiple studies in different population samples have confirmed these associations.4,5 In early studies, the 12-lead ECG was the only available method to diagnose LVH in living subjects. In subsequent years, anatomic LVH diagnosed by echocardiography (echo LVH) became the gold standard.6,7 Despite the development of fairly detailed diagnostic ECG criteria for LVH,8 echocardiographic measurements have virtually replaced the ECG diagnosis of LVH. This shift in clinical practice was driven by the low reported sensitivity (usually <25%), albeit high specificity (up to 95%) of ECG criteria for diagnosis of LVH with echocardiography, magnetic resonance imaging (MRI), or during autopsy.9,10 More recently, however, we are learning that ECG LVH and echo LVH may be clinically distinct entities. In fact, there are now data to suggest that although these 2 entities can often overlap, each may provide distinct prognostic and potentially, mechanistic information, especially in the context of cardiac arrhythmias. This review will attempt to put these findings into perspective for the clinical electrophysiologist, by discussing the significance of electrical versus anatomic LVH for occurrence of atrial fibrillation (AF) and SCD. To diagnose increased left ventricular (LV) mass from the 12-lead ECG, over 30 different ECG criteria have been developed. Most of the commonly used LVH criteria, such as Sokolow and Lyon, and Cornell voltage, rely solely on measuring QRS voltage. …

The effect of obstructive sleep apnea on QRS complex morphology

BackgroundObstructive sleep apnea (OSA) has been reported to be associated with an increased risk of ventricular arrhythmias and conduction disturbances. The aim of this study was to analyze the QRS complex morphology potentially indicative of intraventricular conduction impairment in patients with mild to severe OSA. Material and methodsOne hundred ninety-three consecutive patients, who underwent complete overnight polysomnography, were divided into four groups based on the OSA severity: (1) no OSA, (2) mild OSA, (3) moderate OSA and (4) severe OSA (apnea-hypopnea index <5, 5–15, 15–30, >30/h, respectively). Resting 12-lead ECG was recorded, the QRS parameters included QRS amplitude in individual leads, QRS spatial vector magnitude (QRSmax), electrical axis (EA), ECG criteria for left ventricular hypertrophy (ECG-LVH) and right ventricular hypertrophy (ECG-RVH), and occurrence of fragmented QRS (fQRS). ResultsSeverity of OSA was significantly associated with a gradual significant shift of the electrical axis to the left (45.5±22.5°; 34.8±17.1°; 32.9±18.2°; 29.8±10.0°; respectively), while the QRSmax values were low in all patient groups, with a significant difference between no OSA and severe OSA groups. The multivariate analysis showed that QRSmax was independently associated with age and the interaction between gender and OSA severity (p=0.001, and p=0.004, respectively; adjusted R2=0.178). The electrical axis was found to be independently associated with age and OSA severity (p=0.037, and p=0.026, respectively; R2=0.109). Changes of electrical axis and of QRSmax were reflected in corresponding changes in the amplitude of 12-lead ECG and in low occurrence of ECG-LVH and ECG-RVH criteria. The OSA groups had higher occurrence of fQRS. ConclusionOSA patients displayed a combination of changes in QRS complex morphology, the leftward shift of EA, low QRS voltage and fQRS, suggestive of depolarization sequence deterioration that might be indicative of considerable electrical remodeling.

The Role of ECG in the Diagnosis of Left Ventricular Hypertrophy

The traditional approach to the ECG diagnosis of left ventricular hypertrophy (LVH) is focused on the best estimation of left ventricular mass (LVM) i.e. finding ECG criteria that agree with LVM as detected by imaging. However, it has been consistently reported that the magnitude of agreement is rather low as reflected in the low sensitivity of ECG criteria. As a result, the majority of cases with true anatomical LVH could be misclassified by using ECG criteria of LVH. Despite this limitation, it has been reported that the ECG criteria for LVH provide independent information on the cardiovascular risk even after adjusting for LVM. Understanding possible reasons for the frequent discrepancy between common ECG LVH criteria and LVH by echo or MRI would help understanding the genesis of ECG changes that occur as a consequence of increased LV mass.

Detection of left ventricular hypertrophy in obesity

Detection of left ventricular hypertrophy in obesity

ECG detection of left ventricular hypertrophy

ECG is commonly employed to identify left ventricular hypertrophy (LVH) and a high risk of cardiovascular events (CVE) in hypertensive patients. However, the multiplicity of the existing criteria does not simplify interpretation of the data. We compared a number of common criteria in hypertensive patients by taking as references left ventricular mass (LVM) measured by echocardiography and prediction of incident CVE. The population was a cohort of 958 hypertensive patients (mean age 48 years) recruited before any treatment and having benefited from an ECG and an echocardiography. We evaluated their outcomes at regular intervals. We examined the relationships between several ECG criteria of LVH and LVM as well the occurrence of CVE. Among the various parameters tested (Sokoloff, Cornell, Cornell product) the simple measurement of the RaVL wave offered the best correlations to LVM and the best prediction of the existence of an echocardiographic LVH (receiver-operating characteristic curves). Its alterations were best correlated with the changes in LVM during the follow-up period. Moreover, this simple measurement offered the best performance for the prediction of the occurrence of CVE (123 events after a mean lapse of 12 years). In the interpretation of an ECG in the hypertensive patient, the single measurement of the R wave in aVL gives results at least as good as those of more complicated indices, which do not appear to contribute further to the diagnosis of LVH and the prediction of cardiovascular risk.

Electrocardiographic left ventricular hypertrophy and outcome in hemodialysis patients.

Background and AimsElectrocardiography (ECG) is the most widely used initial screening test for the assessment of left ventricular hypertrophy (LVH), an independent predictor of cardiovascular mortality in patients with end-stage renal disease (ESRD). However, traditional ECG criteria based only on voltage to detect LVH have limited clinical utility for the detection of LVH because of their poor sensitivity.MethodsThis prospective observational study was undertaken to compare the prognostic significance of commonly used ECG criteria for LVH, namely Sokolow-Lyon voltage (SV) or voltage-duration product (SP) and Cornell voltage (CV) or voltage-duration product (CP) criteria, and to investigate the association between echocardiographic LV mass index (LVMI) and ECG-LVH criteria in ESRD patients, who consecutively started maintenance hemodialysis (HD) between January 2006 and December 2008.ResultsA total of 317 patients, who underwent both ECG and echocardiography, were included. Compared to SV and CV criteria, SP and CP criteria, respectively, correlated more closely with LVMI. In addition, CP criteria provided the highest positive predictive value for echocardiographic LVH. The 5-year cardiovascular survival rates were significantly lower in patients with ECG-LVH by each criterion. In multivariate analyses, echocardiographic LVH [adjusted hazard ratio (HR): 11.71; 95% confidence interval (CI): 1.57–87.18; P = 0.016] and ECG-LVH by SP (HR: 3.43; 95% CI: 1.32–8.92; P = 0.011) and CP (HR: 3.07; 95% CI: 1.16–8.11; P = 0.024) criteria, but not SV and CV criteria, were significantly associated with cardiovascular mortality.ConclusionsThe product of QRS voltage and duration is helpful in identifying the presence of LVH and predicting cardiovascular mortality in incident HD patients.

Left ventricular hypertrophy

Left ventricular hypertrophy

Performance of electrocardiographic criteria for left ventricular hypertrophy as compared with cardiac computed tomography: from the Rule Out Myocardial Infarction Using Computer Assisted Tomography trial

Cardiac computed tomography (CT) is a state-of-the-art technology that provides an accurate noninvasive method to quantify left ventricular mass for analysis of left ventricular hypertrophy (LVH). We aimed to examine seven ECG-based LVH criteria against two CT indexation criteria for LVH: a CT-specific body surface area cutoff and the obesity-independent height criteria. In 333 patients (mean age 53 +/- 12 years, 61% men), 64-slice contrast-enhanced CT was performed and 12-lead surface ECG within 24 h. Left ventricular mass was measured at end-diastole. Using both CT indexation criteria, the cohort was subdivided into patients with LVH and without LVH. The seven ECG criteria for LVH were the Cornell voltage index, Cornell voltage duration product, Cornell/strain index, Sokolow-Lyon index, Romhilt-Estes scores at least 4 and at least 5, and Gubner-Ungerleider. The ECG parameters had high specificities (85-97%) and variable low sensitivities (4-43%) when compared to either CT criteria of LVH. The three Cornell-based methods performed the best (test-positive likelihood ratio: 4.5-6.7), followed by the Sokolow-Lyon and Romhilt-Estes scores (test-positive likelihood ratio: 2.3-4.0). With the exception of the Gubner-Ungerleider criterion, the other six ECG criteria were associated with at least one of the CT-based LVH (adjusted odds ratio 2.4-9.5) and had incremental predictive value beyond that of hypertension history. Using cardiac CT as a gold standard for LVH assessment, ECG criteria for LVH have high specificities with the three Cornell-based criteria providing the best test performance for identifying patients with LVH.

QT Peak Prolongation Is Not Associated with Left Ventricular Hypertrophy in Teenage Professional Football Players

QT peak prolongation is associated with left ventricular hypertrophy (LVH) in patients with hypertension. This study tests the hypothesis that QT peak prolongation correlates with LV mass index in apparently healthy young football players. QT peak and other ECG criteria for LVH were assessed in 117 male professional footballers (mean age 16.4 years +/- SD 0.76). Their left ventricular mass index (LVMI) was assessed by transthoracic echocardiography. Heart rate-corrected QT peak (QTpc) interval was measured in lead I using Bazett's formula. Spearman (2-tailed) test and UNIANOVA was used to assess if there were correlations between QT peak and the various echocardiographic and ECG indices of LVH. Echocardiographic LVH, defined as LVMI > or = 134 g/m(2), was seen in 79 (70.5%) subjects. ECG-defined LVH was present in 54 (50 %) players by Sokolow-Lyon criteria, in 19 (16 %) players by Romhilt Score, in 5 (4 %) players by Cornell voltage criteria, and in 7 (6 %) players by Cornell product >2436 mm ms. There was no correlation between QT peak (QTpc) and LVMI on echocardiography (Spearman r = 0.058, 2-tailed P = 0.54). In addition, there was no relation between LVH and QTpc of lead I using any of the following ECG criteria: Sokolow-Lyon (P = 0.6), Romhilt (P = 0.3), Cornell voltage (P = 0.8), or Cornell product (P = 0.6). QT peak interval, which is associated with pathological LVH in hypertensive patients and is a measure of risk of cardiac death, does not correlate with LVH characterized by myocyte hypertrophy in young apparently healthy professional footballers.

Evaluation of the Electrocardiographic Criteria for Left Ventricular Hypertrophy With Use of Three‐Dimensional Echocardiography

Left ventricular hypertrophy (LVH) is a common condition that carries an increased risk of cardiovascular events. Use of ECG in detection of LVH is limited because of the reported low sensitivity. Conventional echocardiographic techniques used as the standard for estimating left ventricular (LV) mass have limitations related to the position of the image plane and shape of the ventricle. Three-dimensional echocardiography is free of these limitations and therefore is more accurate. We hypothesized that accuracy of ECG criteria for LVH would improve when LV mass was assessed by three-dimensional echocardiography. For most of the criteria, sensitivity, specificity and accuracy improved when LV mass was assessed by three-dimensional echocardiography. Two-dimensional echocardiography significantly overestimated LV mass as compared with the three-dimensional method. Sensitivity, specificity, and accuracy of the ECG criteria improved when LV mass was estimated by three-dimensional echocardiography. This improvement may be attributed at least in part to superior accuracy of three-dimensional measurements.

Relation of echocardiographic left ventricular mass and hypertrophy to persistent electrocardiographic left ventricular hypertropy in hypertensive patients: the LIFE study

Background: The Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) trial used left ventricular hypertrophy (LVH) on a screening ECG to identify patients at high risk for morbid events. Because of regression to the mean, not all patients who met screening criteria had persistent ECG LVH on the ECG performed at study baseline. Methods: The relationship of echocardiographic LV mass and LVH to persistence or loss of ECG LVH between screening and baseline evaluation was examined in 906 hypertensive patients in the LIFE study, who had echocardiograms and additional ECG performed at study baseline. Patients were categorized according to the presence or absence of ECG LVH by Cornell voltage-duration product criteria or Sokolow-Lyon voltage criteria; echocardiographic LVH was defined by LV mass index (LVMI) > 104 g/m 2 in women and > 116 g/m 2 in men. Results: A total of 678 patients (75%) had persistent ECG LVH at baseline evaluation. Compared with the 228 patients without ECG LVH on the second ECG by either criterion, the 106 patients with LVH by both Cornell product and Sokolow-Lyon criteria had significantly higher LVMI (140 ± 31 v 114 ± 21 g/m 2, P < .001) and a higher prevalence of echocardiographic LVH (86% v 55%, P < .001). Patients with ECG LVH on the baseline ECG by either Cornell product criteria ( n = 410) or Sokolow-Lyon voltage criteria ( n = 162) had intermediate values of LVMI (125 ± 25 and 121 ± 21 g/m 2) and prevalences of echocardiographic LVH (78% and 62%). After controlling for possible effects of age, sex, ethnicity, systolic blood pressure, and body mass index, persistence of ECG LVH on the baseline ECG was associated with an increased risk of echocardiographic LVH: compared with patients with neither ECG criteria for LVH, patients with only Sokolow-Lyon voltage criteria had a 1.2-fold increased risk of echocardiographic LVH, those with only Cornell product criteria had a 2.7-fold increased risk, and patients with both ECG criteria had a 4.1-fold increased risk of echocardiographic LVH ( P < .001). Conclusions: Persistent ECG LVH between screening and LIFE study baseline identified patients with greater LV mass and a higher prevalence of echocardiographic LVH, suggesting that these patients may be at higher risk for subsequent morbid and mortal events.

Performance of classic electrocardiographic criteria for left ventricular hypertrophy in an African population.

ECG criteria for left ventricular hypertrophy (LVH) have been almost exclusively elaborated and calibrated in white populations. Because several interethnic differences in ECG characteristics have been found, the applicability of these criteria to African individuals remains to be demonstrated. We therefore investigated the performance of classic ECG criteria for LVH detection in an African population. Digitized 12-lead ECG tracings were obtained from 334 African individuals randomly selected from the general population of the Republic of Seychelles (Indian Ocean). Left ventricular mass was calculated with M-mode echocardiography and indexed to body height. LVH was defined by taking the 95th percentile of body height-indexed LVM values in a reference subgroup. In the entire study sample, 16 men and 15 women (prevalence 9.3%) were finally declared to have LVH, of whom 9 were of the reference subgroup. Sensitivity, specificity, accuracy, and positive and negative predictive values for LVH were calculated for 9 classic ECG criteria, and receiver operating characteristic curves were computed. We also generated a new composite time-voltage criterion with stepwise multiple linear regression: weighted time-voltage criterion=(0.2366R(aVL)+0.0551R(V5)+0.0785S(V3)+ 0.2993T(V1))xQRS duration. The Sokolow-Lyon criterion reached the highest sensitivity (61%) and the R(aVL) voltage criterion reached the highest specificity (97%) when evaluated at their traditional partition value. However, at a fixed specificity of 95%, the sensitivity of these 10 criteria ranged from 16% to 32%. Best accuracy was obtained with the R(aVL) voltage criterion and the new composite time-voltage criterion (89% for both). Positive and negative predictive values varied considerably depending on the concomitant presence of 3 clinical risk factors for LVH (hypertension, age >/=50 years, overweight). Median positive and negative predictive values of the 10 ECG criteria were 15% and 95%, respectively, for subjects with none or 1 of these risk factors compared with 63% and 76% for subjects with all of them. In conclusion, the performance of classic ECG criteria for LVH detection was largely disparate and appeared to be lower in this population of East African origin than in white subjects. A newly generated composite time-voltage criterion might provide improved performance. The predictive value of ECG criteria for LVH was considerably enhanced with the integration of information on concomitant clinical risk factors for LVH.

Classification Accuracy of Electrocardiographic Criteria for Left Ventricular Hypertrophy in Normal Weight and Overweight Older Adults

Background: We evaluated classification accuracy of ECG criteria at varying levels of left ventricular hypertrophy (LVH) severity according to echocardiographically measured left ventricular mass (LVM) adjusted to body size.Methods: The test population was derived from the Cardiovascular Health Study (CHS), a population‐based sample of 5201 men and women aged 65 and older, and consisted of 1844 women and 1119 men with adequate quality ECGs and echocardiograms for LVM determination. The criteria evaluated were Sokolow‐Lyon, Cornell voltage, Cornell product, Framingham modification of the Cornell voltage, and the left ventricular mass index (LVMI) of the Novacode ECG program.Results: With LVH thresholds at upper 95% normal limit for weight adjusted LVM for the CHS population and ECG thresholds adjusted for 95% specificity in normal weight and overweight subgroups, the sensitivity of ECG criteria for LVH was relatively low. It was highest (40.8%) for the Novacode LVMI in normal weight men and for the Framingham criteria (30.9%) in normal weight women, but it deteriorated for both of these criteria in the presence of obesity. The overall performance of the Cornell product and Cornell voltage criteria was least influenced by obesity. The Framingham adjustment for the Cornell voltage criteria for obesity substantially reduced their sensitivity.Conclusion: The choice of echocardiographic standard, LVH severity level and overweight in the test groups have a strong influence on ECG evaluation results.