Electrocardiogram Left Ventricular Hypertrophy Research Articles

ECG left ventricular hypertrophy in aortic stenosis: Relationship with cardiac structure, invasive hemodynamics, and long-term mortality.

In aortic stenosis (AS), left ventricular hypertrophy (LVH) is the response to pressure overload and represents the substrate for a maladaptive cascade, the so-called AS-related cardiac damage. We hypothesized that in AS patients electrocardiogram (ECG) LVH not only predicts echocardiography LVH but also other noninvasive and invasive markers of cardiac damage and prognosis after aortic valve replacement (AVR). In 279 patients with severe AS undergoing ECG, echocardiography, and cardiac catheterization before AVR, the Sokolow-Lyon index, the Cornell product, the Romhilt-Estes score, and the Peguero-Lo Presti score were assessed. The mean left ventricular mass index was 109 ± 34 g/m2 , and 131 (47%) patients had echocardiography LVH. The areas under the receiver operator characteristics curve (AUC) for the Sokolow-Lyon index, the Cornell product, the Romhilt-Estes score, and the Peguero-Lo Presti score for the prediction of echocardiography LVH were 0.59, 0.70, 0.63, and 0.65. The Peguero-Lo Presti score had the numerically greatest AUC for the prediction of left ventricular end-diastolic pressure >15 mmHg, mean pulmonary artery wedge pressure >15 mmHg, pulmonary vascular resistance >3 Wood units, mean right atrial pressure >14 mmHg, and stroke volume index <31 mL/m2 . After a median follow-up of 1365 (interquartile range: 931-1851) days after AVR only the Peguero-Lo Presti score was significantly associated with all-cause mortality [hazard ratio: 1.24 (95% confidence interval: 1.01-1.54); per 1 mV increase; p = .045]. Among severe AS patients, the Peguero-Lo Presti score is associated with abnormalities in cardiac structure including LVH, invasive measures of cardiac damage, and long-term mortality after AVR.

AVERAGE ACHIEVED BP &lt;130/80 MMHG IN HIGH-RISK MIDDLE-AGED AND OLDER HYPERTENSIVE PATIENTS PROVIDES STRONG CARDIOVASCULAR PROTECTION EXCEPT IN LEFT VENTRICULAR HYPERTROPHY

Objective: Evidence that reducing blood pressure (BP) to &lt;130/80 mmHg rather than to &lt;140/90 mmHg by antihypertensive treatment in hypertensive patients is conflicting. Left ventricular hypertrophy (LVH) is common in hypertension, and low perfusion pressure may result in ischemia in patients with LVH. We investigated whether average achieved BP &lt;130/80 mmHg implied cardiovascular benefits in high-risk middle-aged and older hypertensive patients who participated in the VALUE Trial. Considering a previous report of excess mortality in LVH patients with in-treatment systolic BP (SBP) &lt;130 mmHg, we paid special attention to whether the average achieved SBP &lt;130 mmHg may cause harm in similar patients with LVH. Design and method: Of the 15,245 participants, we identified 13,803 patients without cardiovascular events during the first six months after randomization during which previous medications were discontinued and study drugs up-titrated. Of these, 2,458 patients had LVH on an electrocardiogram (ECG). Cox analyses adjusted for age, gender, and baseline variables compared cardiac and all-cause mortality and other pre-specified endpoints for patients who achieved average SBP 130 - 139 mmHg (No LVH group n = 4,863, ECG LVH group n = 929) and &lt;130 mmHg (No LVH group n = 2,107, ECG LVH group n = 305). Reference groups were patients who achieved an average SBP &gt; = 140 mmHg following the first excluded six months (No LVH group n = 4,375, ECG LVH group n = 1,224). Results: The No LVH group with average achieved BP &lt;130/80 mmHg had a significantly lower incidence of all endpoints except for myocardial infarction. The ECG LVH group with average achieved SBP &lt;130 mmHg had increased cardiac mortality (HR = 1.98, p = 0.032) and all-cause mortality (HR = 1.74, p = 0.007), and SBP &lt;130 mmHg was not associated with a reduction in any endpoint. However, as in those without LVH, the ECG-LVH group had fewer strokes and heart failure with an average achieved diastolic BP &lt;80 mmHg. Conclusions: Our data suggest that target SBP &lt;130 mmHg may cause harm and needs further investigation in middle-aged and older patients with LVH detected by ECG. Otherwise, the average achieved BP &lt;130/80 mmHg prevents most cardiovascular endpoints in middle-aged and older hypertensive patients with high cardiovascular risk but without LVH.

Apparent electrocardiogram left ventricular hypertrophy during tachycardia

The electrocardiographic transient display of left ventricular hypertrophy (LVH), during rapid heart rates, in the setting of sinus/supraventricular tachycardias and atrial fibrillation, is illustrated via 3 case reports. This common occurrence is expressed by an increase in the S-waves in leads V2-V5, during tachycardias, rendering a false positive diagnosis of LVH by the frequently employed Cornell voltage LVH criteria. This tachycardia-mediated apparent LVH, is unrelated to the occasionally encountered stable, and unrelated to tachycardia, “false positive diagnosis of LVH”, which could in reality occasionally reflect altered electrical properties of myocardium that could create a functional substrate for developing arrhythmias. The importance of awareness of this insight by all health professionals is immeasurable, considering that a false positive diagnosis of LVH has major consequences in the management, prognostication, resort to expensive unnecessary testing, and stress to the patients and their families.

Correlation between Left Ventricular Hypertrophy in Electrocardiogram and Hypertension in Physical Examination Population

To explore the correlation between left ventricular hypertrophy in electrocardiogram and hypertension in the population underwent physical examination. A total of 96 patients who underwent physical examination in our hospital from February 2019 to February 2020 were selected as the research subjects. 48 patients with normal electrocardiogram were selected as the control group and 48 patients with left ventricular hypertrophy showed by electrocardiogram were selected as the observation group. 24 h systolic blood pressure, 24 h diastolic blood pressure, nocturnal systolic blood pressure, nocturnal diastolic blood pressure, the standard deviation of 24 h systolic blood pressure, the standard deviation of nocturnal systolic blood pressure and the standard deviation of nocturnal diastolic blood pressure were compared between the two groups. Compared with the control group, there were 20 patients with hypertension in the observation group and the detection rate was 41.67 %. There were 3 patients with hypertension in the control group and the detection rate was 6.25 %. The detection rate of hypertension in the observation group was significantly higher than that in the control group (p<0.05). Compared with the control group, 24 h systolic blood pressure, 24 h diastolic blood pressure, nocturnal systolic blood pressure, nocturnal diastolic blood pressure, the standard deviation of 24 h systolic blood pressure, the standard deviation of nocturnal systolic blood pressure and the standard deviation of nocturnal diastolic blood pressure in observation group were significantly increased (p<0.05). The incidence of myocardial infarction and sudden death in observation group was significantly higher than that in control group (p<0.05). The left ventricular hypertrophy shown by electrocardiogram is of great value to the detection rate of hypertension in physical examination. It can evaluate the blood pressure status of patients and has good clinical application value.

Diagnostic performance of electrocardiographic criteria in echocardiographic diagnosis of different patterns of left ventricular hypertrophy.

BackgroundElectrocardiogram (ECG) is considered the initial screening method for the detection of left ventricular hypertrophy (LVH) despite its low sensitivity. However, there are no data on how ECG criteria for LVH perform in patients with concentric (cLVH) and eccentric LVH (eLVH).MethodsIn the setting of the Corinthia cross‐sectional study, ECGs were analyzed in 1,570 participants of the study. Seven ECG LVH criteria were calculated (Sokolow–Lyon voltage, index, and product, sex‐specific Cornell voltage and product, Lewis voltage, and the Framingham), whereas LVH was defined, based on echocardiographic data, as left ventricular mass indexed for body surface area (BSA) of at least 125 g/m2 in men and at least 110 g/m2 in women.ResultsRegarding the frequency encountered for each ECG LVH criterion, there was no difference between eLVH and cLVH. However, when ECG criteria were compared as continuous variables between LVH groups, Cornell voltage and product were higher in cLVH individuals, with a value of Cornell voltage >13.95 mV having 61% sensitivity and 62% specificity to differentiate cLVH from eLVH (p = .05). Even after adjustment for age, sex, body mass index, and hypertension, the occurrence of Cornell voltage or product increased the odds of cLVH by 1.6 times (p = .001).ConclusionCornell voltage and product criteria disclosed a superior discriminative ability for the detection of LVH via ECG. When further categorizing LVH as concentric and eccentric, Cornell product depicted the higher discriminative ability for cLVH.

Abstract P286: Short-Term Repeatability of Electrocardiographic Criteria of Left Ventricular Hypertrophy

Background: Left ventricular hypertrophy (LVH) is a marker of cardiac end-organ damage and a risk factor for cardiovascular morbidity and mortality. Although electrocardiogram (ECG) is the most common tool for LVH assessment in contemporary clinical trials and cohort studies, the repeatability of ECG-LVH criteria has not been sufficiently examined. Objectives: Characterize the repeatability and minimal detectable change of ECG-LVH criteria. Methods: A total of 63 participants (mean age 50 years; 31 females) underwent two visits one week apart. At each visit, two digital ECGs were obtained following a standardized protocol. The ECG data were processed centrally to automatically obtain waveform measurements needed to calculate Cornell voltage (CV) LVH (SV3 + RaVL &gt;2800 μV for men and &gt;2000 μV for women), Cornell voltage product (CVP) LVH ((RaVL + SV3) X QRS duration ≥244 mV sec; for both Cornell criteria, 0.8 mV was added to the voltage sum for women), and Sokolow-Lyon (SL) LVH (SV1 +RV5/V6 ≥3500 μV). In addition to using these criteria as dichotomous LVH variables, we also used the waveforms measurements composing them as continuous variables, referred to here as CV-index, CVP-index, and SL-index. We used random-effects, mixed models to parse the variance of the variables into their between-participant, between-visit, and within-visit components, and calculated the intra-class correlation coefficient (ICC), minimal detectable change (95% confidence), and Kappas. Results: Between-participant variation accounted for 93% to 97% of the total variation in CV-index, CVP-index, and log of SL-index. The ICCs (95% confidence intervals) 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 ≥236.7 μV, ≥26.7 mV, and ≥0.09 μV, respectively. The within-visit Kappa (95% confidence limits) was 0.73 (0.38, 1.00) for SL LVH and 1 for the other two LVH criteria. The between-visit Kappa was 1 for CV LVH, 0.66 (0.04, 1.00) for CVP LVH, and 0.40 (-0.03, 0.83) and 0.64 (0.26, 1.00) for the SL LVH first and second measurements of each visit, respectively. When defining ECG-LVH as presence of ≥1 ECG-LVH criteria, the within visit Kappa became 0.78 (0.49, 1.00) for the first visit and 1 for the second visit; the between visit Kappa values became 0.50 (0.12, 0.88) and 0.70 (0.38, 1.00) for the first and second measurements of each visit. Conclusion: CV, CVP, SL indices as continuous variables have excellent repeatability. The dichotomous ECG-LVH criteria have excellent within visit agreement, but between visit agreement ranges from fair to poor, which improved by combining multiple criteria. These results alleviate concerns about the repeatability the ECG LVH use in clinical trials and epidemiologic studies.

Electrocardiographic left ventricular hypertrophy predicts recurrence of atrial arrhythmias after catheter ablation of paroxysmal atrial fibrillation.

Left ventricular hypertrophy (LVH) is an independent predictor of new-onset atrial fibrillation. Whether LVH can predict the recurrence of arrhythmia after radiofrequency catheter ablation (RFCA) in patients with paroxysmal atrial fibrillation (PAF) remains unclear. PAF patients with baseline-electrocardiographic LVH has a higher recurrence rate after RFCA procedure compared with those without LVH. A total of 436 patients with PAF undergoing first RFCA were consecutively enrolled and clustered into 2 groups based on electrocardiogram (ECG) findings: non-ECG LVH (218 patients) and ECG LVH (218 patients). LVH was characterized by the Romhilt-Estes point score system; the score ≥5points were defined as LVH. At 42 months' (interquartile range, 18.0-60.0 months) follow-up after RFCA, 151 (69.3%) patients in the non-ECG LVH group and 108 (49.5%) patients in the ECG LVH group maintained sinus rhythm without using antiarrhythmic drugs (P < 0.001). Patients with ECG LVH tended to experience a much higher prevalence of stroke and recurrence of atrial arrhythmia episodes compared with those without ECG LVH (log-rank P < 0.001). Multivariate analysis found the presence of ECG LVH and left atrial diameter to be independent risk factors for recurrence after adjusting for confounding factors. The presence of ECG LVH was a strong and independent predictor of recurrence in patients with PAF following RFCA.

Effect of coexisting hypertension, blood pressure control, and antihypertensive treatment on QT interval parameters in type 2 diabetics: A cross-sectional study

Objectives: To study the electrocardiogram (ECG) based QT parameters namely QTc (heart rate corrected QT), QTd (QT dispersion) in treated type 2 diabetics (T2D) and the effect of hypertension (HTN), blood pressure (BP) control, and antihypertensives used on the above parameters. Materials and Methods: We performed a cross-sectional study in a tertiary care hospital of Gujarat, India, on 199 T2D (67 males and 132 females). Standard 12-lead ECG was recorded to derive QTc (Bazett's formula), QTd, and ECG left ventricular hypertrophy (LVH). QTc >0.43 s in male and >0.45 s in female and QTd >80 msec were considered abnormal. Results: Hypertensives (n = 138) and normotensives (n = 61) were comparable for most confounders. Hypertensives had better profile of QTc and QTd than normotensives. T2D with controlled BP revealed slightly better, though insignificant; QTc, QTd than those with BP uncontrolled. QT parameters were not significantly correlated with age, heart rate, or BP. Qualitative differences exceeded quantitative difference in QTc and QTd evaluation. There was no significant effect of use or nonuse of preventive pharmacotherapy on QT parameters. Conclusion: Low-to-moderate prevailing cardiac repolarization abnormality in T2D with very low ECG LVH was unaffected by HTN as a disease, its control status, and treatment modalities suggesting primary preventive role of antihypertensive use without class difference.

Limited Relationship of Voltage Criteria for Electrocardiogram Left Ventricular Hypertrophy to Cardiovascular Mortality

BackgroundNumerous methods have been proposed for diagnosing left ventricular hypertrophy using the electrocardiogram. They have limited sensitivity for recognizing pathological hypertrophy, at least in part due to their inability to distinguish pathological from physiological hypertrophy. Our objective is to compare the major electrocardiogram–left ventricular hypertrophy criteria using cardiovascular mortality as a surrogate for pathological hypertrophy. MethodsThis study was a retrospective analysis of 16,253 veterans < 56 years of age seen at a large Veterans Affairs Medical Center from 1987 to 1999 and followed a median of 17.8 years for cardiovascular mortality. Receiver operating characteristics and Cox hazard survival techniques were applied. ResultsOf the 16,253 veterans included in our target population, the mean age was 43 years, 8.6% were female, 33.5% met criteria for electrocardiogram–left ventricular hypertrophy, and there were 744 cardiovascular deaths (annual cardiovascular mortality 0.25%). Receiver operating characteristic analysis demonstrated that the greatest area under the curve (AUC) for classification of cardiovascular death was obtained using the Romhilt-Estes score (0.63; 95% confidence interval, 0.61-0.65). Most of the voltage-only criteria had nondiagnostic area under the curves, with the Cornell being the best at 0.59 (95% confidence interval, 0.57-0.62). When the components of the Romhilt-Estes score were examined using step-wise Wald analysis, the voltage criteria dropped from the model. The Romhilt-Estes score ≥ 4, the Cornell, and the Peguero had the highest association with cardiovascular mortality (adjusted hazard ratios 2.2, 2.0, and 2.1, consecutively). ConclusionNone of the electrocardiogram leads with voltage criteria exhibited sufficient classification power for clinical use.

QT corrected for heart rate and qtc dispersion in Gujarati type 2 diabetics predominantly using preventive pharmacotherapy and with very low electrocardiogram left ventricular hypertrophy

Background: There is a rising trend in the incidence of type 2 diabetes mellitus, and hyperglycaemia is known to cause cardiac dysautonomia, which may lead to life-threatening arrhythmias. It can be screened by simple electrocardiogram (ECG)-based QTc (QT corrected for heart rate) and QTd (QTc dispersion) indicating cardiac repolarisation abnormality. We studied QTc and QTd intervals in treated type 2 diabetics (T2D), testing the effect of age, gender, duration and control of disease. Materials and Methods: We conducted a cross-sectional study in a tertiary care teaching hospital of Gujarat, India, on 199 T2D (67 males and 132 females). Standard 12-lead ECG was recorded to derive QTc by Bazett's formula, QTd and ECG left ventricular hypertrophy (LVH). QTc >0.43 s in male and >0.45 s in female, QTd >80 msec were considered abnormal. Results: T2D (mean age 56 years, duration 6 years, coexisting hypertension 69%, glycaemic control 32% and use of β-blockers 56%) had QTc and QTd abnormality prevalence 15% and 20% respectively with ECG LVH prevailing in 3%. Male gender, poor glycaemic control and increased duration had negative impact on QT parameters with statistical significance only for first two and not for all results. Conclusion: Our study showed low-to-moderate prevalence of prolonged QTc and QTd, qualitatively more than quantitatively, in T2D with very low LVH and high prevalence of preventive pharmacotherapy, associated with male gender and glycaemic control. It underscores high risk of repolarisation abnormality, though moderate, that can be further primarily prevented by early screening and strict disease control.

Delayed intrinsicoid deflection of the QRS complex is associated with sudden cardiac arrest

Prolongation of initial ventricular depolarization on the 12-lead electrocardiogram (ECG), or delayed intrinsicoid deflection (DID), can indicate left ventricular hypertrophy (LVH). The possibility that this marker could convey distinct risk of sudden cardiac arrest (SCA) has not been evaluated. To evaluate the association of DID and SCA in the community. In the ongoing prospective, population-based Oregon Sudden Unexpected Death Study (Oregon SUDS; catchment area approximately 1 million), SCA cases were compared to geographic controls with no SCA. Archived ECGs (closest and unrelated to SCA event for cases) were evaluated for the presence of DID, defined as ≥0.05 second in leads V5 or V6. Left ventricular (LV) mass and function were evaluated from archived echocardiograms. SCA cases (n = 272, 68.7 ± 14.6 years, 63.6% male) as compared to controls (n = 351, 67.6 ± 11.4 years, 63.3% male) were more likely to have DID on ECG (28.3% vs. 17.1%, P = .001). DID was associated with increased SCA odds (odds ratio [OR] 1.92; 95% confidence interval [CI] 1.31-2.81; P = .001), but showed poor correlation with LV mass and echocardiographic LVH (kappa 0.13). In multivariate analysis adjusted for clinical and ECG markers, reduced LV ejection fraction, and echocardiographic LVH, DID remained an independent predictor of SCA (OR 1.82; 95% CI 1.12-2.97; P = .016). Additionally, in a sensitivity analysis restricted to narrow QRS, DID and ECG LVH by voltage were each independently associated with SCA risk. DID was associated with increased SCA risk independent of echocardiographic LVH, ECG LVH, and reduced LV ejection fraction, potentially reflecting unique electrical remodeling that warrants further investigation.

Abstract 12449: The Electrocardiogram Left Ventricular Hypertrophy With Strain Pattern Predicts Recurrence in Paroxysmal Atrial Fibrillation Patients After Radiofrequency Catheter Ablation

Introduction: The present of left ventricular hypertrophy (LVH) or LVH with strain pattern on electrocardiogram (ECG) are independently predictors of new-onset atrial fibrillation (AF). Hypothesis: We assessed the hypothesis that LVH with or without strain can predict recurrence after radiofrequency catheter ablation (RFCA) of AF in paroxysmal atrial fibrillation (PAF) patients. Methods: 436 PAF patients undergoing RFCA were enrolled and clustered into 3 subgroups: Non-LVH (218 patients), LVH (182 patients), LVH with strain (36 patients). LVH was characterized by the Romhilt-Estes point system and ECG strain was defined as ST-segment depression≥1-mm and T-wave inversion≥1 mm in the lateral leads. Results: After 42 (interquartile range, 18.0 to 60.0 months) months follow-up period with a median of 1 (1 to 3) RFCA procedure, sinus rhythm was maintained in 248 patients (60.2%) without antiarrhythmic drugs. Patients with LVH (79, 43.6%) and LVH with strain (22, 62.9%) tended to experience much higher AF episodes recurrence ratio compared to those with non-LVH (71, 33.3%; P=0.000). In multivariate analysis after adjustment for age, sex, CHA2SDVAS score and left atrial diameter (LAD), the present of LVH with strain was the only independent risk factor of AF recurrence (95%CI: 1.242 to 5.808, P=0.012). Conclusions: That present of LVH with strain but not LVH alone is a strong and independent predictor of AF recurrence in PAF patients following RFCA.

The relationship between electrocardiographic left ventricular hypertrophy criteria and echocardiographic mass in patients undergoing transcatheter aortic valve replacement

IntroductionCalcific aortic stenosis (AS) is a common valvular disease among the elderly. Often, AS leads to left ventricular hypertrophy (LVH) and symptoms of heart failure. Severe AS can be treated by transcatheter aortic valve replacement (TAVR). Previous studies have shown that electrocardiogram (ECG) criteria for LVH correlate poorly with left ventricular mass (LVM) in echocardiography. However, such correlations have not been studied in TAVR patients. AimsTo evaluate ECG LVH criteria as a method of diagnosing and quantifying LVH in patients with AS undergoing TAVR. Material and methodsTwenty-four patients, with neither pacemaker nor bundle branch block, who had undergone pre-TAVR ECG and echocardiography were included. The ECGs were evaluated using the Sokolow–Lyon, Romhilt–Estes and Cornell Voltage criteria for LVH as well as spatial maximal QRS-T angle and 3D QRS maximal spatial vector. The LVM was measured by echocardiography. Results15 (63%) patients met the echocardiographic threshold for LVH. 7 patients (29%) were positive by the Sokolow–Lyon, 5 (21%) by the Romhilt–Estes and 12 (50%) by the Cornell Voltage criteria for LVH. There was no correlation between LVM and conventional ECG LVH criteria or spatial parameters. QRS duration correlated with LVM (r=0.56, R2=0.31, p=0.005). However, there was no correlation between QRS duration and LVM index or relative wall thickness (RWT). ConclusionsIn TAVR patients, none of the ECG LVH criteria should be used for evaluation of LVM. QRS duration is moderately correlated to LVM and is the most useful ECG estimate of LVM.

T-wave morphology analysis of competitive athletes

BackgroundT-wave morphology has been shown to be more sensitive than QT and QTc interval to describe repolarization abnormalities. The electrocardiogram (ECG) performed in athletes may manifest abnormalities, including repolarization alterations. The aim of this study was to investigate the characteristics of T-wave morphology features in athletes. MethodsEighty male elite athletes, consisting of 40 Tour de France cyclists (age 27±5years), 40 soccer players (age 26±6years) and 40 healthy men (age 27±5years) were included. ResultsSinus bradycardia, left ventricular (LV) hypertrophy, incomplete right bundle branch block and early repolarization were documented in 25 %, 20%, 13% and 14% of athletes, respectively. ECG criteria for LV hypertrophy in 12-lead ECG were more common in cyclists (35%) than in soccer players (5%), P<0.0001. Cyclists and soccer players had significantly longer RR interval, and repolarization features than the control group. ConclusionsT-wave morphology of athletes is different from non-athletes, depending of the sport. Decreased potassium current in cardiomyocytes associated with LVH may contribute to these changes.

Left ventricular hypertrophy: The relationship between the electrocardiogram and cardiovascular magnetic resonance imaging.

Conventional assessment of left ventricular hypertrophy (LVH) using the electrocardiogram (ECG), for example, by the Sokolow-Lyon, Romhilt-Estes or Cornell criteria, have relied on assessing changes in the amplitude and/or duration of the QRS complex of the ECG to quantify LV mass. ECG measures of LV mass have typically been validated by imaging with echocardiography or cardiovascular magnetic resonance imaging (CMR). However, LVH can be the result of diverse etiologies, and LVH is also characterized by pathological changes in myocardial tissue characteristics on the genetic, molecular, cellular, and tissue level beyond a pure increase in the number of otherwise normal cardiomyocytes. For example, slowed conduction velocity through the myocardium, which can be due to diffuse myocardial fibrosis, has been shown to be an important determinant of conventional ECG LVH criteria regardless of LV mass. Myocardial tissue characterization by CMR has emerged to not only quantify LV mass, but also detect and quantify the extent and severity of focal or diffuse myocardial fibrosis, edema, inflammation, myocarditis, fatty replacement, myocardial disarray, and myocardial deposition of amyloid proteins (amyloidosis), glycolipids (Fabry disease), or iron (siderosis). This can be undertaken using CMR techniques including late gadolinium enhancement (LGE), T1 mapping, T2 mapping, T2* mapping, extracellular volume fraction (ECV) mapping, fat/water-weighted imaging, and diffusion tensor CMR. This review presents an overview of current and emerging concepts regarding the diagnostic possibilities of both ECG and CMR for LVH in an attempt to narrow gaps in our knowledge regarding the ECG diagnosis of LVH.

Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: A systematic review and meta-analysis

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Mitral Annular Calcification and Incident Ischemic Stroke in Treated Hypertensive Patients: The LIFE study.

Background Fibro-calcification of the mitral annulus (MAC) has been associated with increased risk of ischemic stroke in general populations. This study was performed to assess whether MAC predicts incidence of ischemic stroke in treated hypertensive patients with left ventricular hypertrophy (LVH). Methods Baseline and follow-up clinical and echocardiographic parameters were assessed in 939 hypertensive patients with electrocardiogram (ECG) LVH participating in the Losartan Intervention for Endpoint reduction in hypertension (LIFE) echocardiography substudy (66±7 years; 42% women; 11% with diabetes) who did not have aortic or mitral valve stenosis or prosthesis. Results MAC was found in 458 patients (49%). Patients with MAC were older (68±7 vs. 65±7 years); were more often women (47% vs. 37%); had higher baseline systolic blood pressure (BP) (175±14 vs. 172±15mm Hg), left atrial diameter (4.0±0.5 vs. 3.8±0.6cm), and left ventricular mass index (58±13 vs. 55±12g/m(2.7)) and included more patients with proteinuria (30% vs. 21%; all P < 0.01). During a mean follow-up of 4.8 years, 58 participants had an ischemic stroke. Risk of incident ischemic stroke was significantly related to presence of MAC (log rank = 9; P < 0.01). In multivariable Cox regression analysis models, MAC was associated with increased risk of ischemic stroke (hazard ratio = 1.78-2.35), independent of age, baseline or time-varying systolic BP, prevalence or incidence of atrial fibrillation, history of previous cerebrovascular disease, and other well-recognized confounders, such as sex, time-varying left ventricular mass, left atrial diameter, and urinary albumin/creatinine ratio (all P < 0.05). Conclusions MAC is common in treated hypertensive patients with ECG LVH and is an independent predictor of incident ischemic stroke.

Adherence to Antihypertensive Medications and Some of Its Clinical Implications in Patients Seen At a Tertiary Hospital in Nigeria

Abstract: Background: Adherence to antihypertensive is crucial to treatment success in subjects with hypertension. This study is aimed at assessing antihypertensive drug adherence using validated tool and its relationship with some demographic and clinical parameters in outpatient hypertensive subjects. Methods:The Morisky Medication Adherence Scale (MMAS-4) was used to assess drug adherence status in 150 hypertensive patients who were consecutively recruited in a Medical Outpatient Department of a Tertiary Health Centre. All the patients had resting 12- lead electrocardiogram (ECG) done to determine left ventricular hypertrophy (LVH). Data were analyzed with SPSS 13 and statistical significance of p< 0.05 was used. Results: One hundred and fifty hypertensive patients with a mean age of 61.53± 9.72years were recruited over a period of 6 months. Sixty seven (44.7%) were good drug adherers while 55.3% were not. Patients with poor antihypertensive adherence had higher Sokolow- Lyon ECG score (34.46 ± 7.87 vs. 22.96 ± 7.07; p= 0.07) as well as longer P wave duration on ECG (0.15 ± 0.03 vs. 0.12± 0.04; p= 0.03). There was higher rate of ECG LVH among patients with poor drug adherence (47.0%) compared to patients with good drug adherence (4.5%). Significant correlates of poor drug adherence were age (r= - 0.221; p=0.022) and BMI (r= 0.431; P<0.001). Conclusion:The rate of poor drug compliance was high with preponderance of LVH in poor adherer. Physicians will do well to engage their hypertensive patients on hypertension and its treatment with a view to improving drug adherence in them. Keywords: Medication, adherence, hypertension, electrocardiogram

The Prognostic Value of Electrocardiographic Estimation of Left Ventricular Hypertrophy in Dialysis Patients

Left ventricular hypertrophy (LVH) is associated with poor cardiovascular outcome in CKD. Electrocardiogram (ECG) is low-cost but infrequently used to assess presence of LVH in dialysis patients. The aim of this study was to establish which ECG-determined LVH method is most sensitive in dialysis patients, and also most predictive of death. This was a longitudinal observational study in dialysis patients from a single center, undergoing interval ECGs. Fourteen methods of ECG LVH assessment were compared. Survival was also compared between four LVH evolutionary categories: persistent LVH; new LVH; LVH regression; and no LVH. The study included 418 dialysis patients (46.3% women, mean age 51 years, mean follow up 67 months, 76 deaths, 37 cardiovascular deaths). LVH prevalence varied according to method (range 13.4-41.9%). No measurement predicted all-cause mortality. After Cox regression, there was an independent association between LVH and cardiovascular mortality using Novacode (HR = 3.04; 95% [CI] = 1.11-8.28, P < 0.05), but not with other methods. Patients with persistent ECG changes of LVH had increased risk of cardiovascular mortality compared to other LVH evolutionary categories (P < 0.044). ECG scoring of LVH can be predictive of cardiovascular mortality. The Novacode method, based on repolarization abnormalities, is a better predictor than standard ECG techniques that are based on voltage criteria. Novacode LVH estimation at dialysis initiation may prove to be a noninvasive and cost-effective bedside tool for cardiovascular risk stratification in patients receiving dialysis.

Alterations in the QRS complex in the offspring of patients with metabolic syndrome and diabetes mellitus: early evidence of cardiovascular pathology

ObjectiveThis study was undertaken to evaluate the nature and onset of changes in the QRS complex in the offspring of patients with diabetes mellitus (DM) and metabolic syndrome (MetS). Methods and MethodsA total of 529 subjects, divided into 5 groups, were included in the study: (i) group DM (n = 92), patients with DM; (ii) group MetS (n = 125), patients with MetS; (iii) group O-DM (n = 109), offspring of patients with DM; (iv) group O-MetS (n = 122), offspring of patients with MetS; and (v) group HO (n = 81), offspring of healthy subjects. QRS parameters analyzed included amplitude, maximum QRS spatial vector magnitude, electrical axis (EA), and 3 electrocardiogram (ECG) criteria for left ventricular hypertrophy based on amplitude criteria: Sokolow-Lyon index, Cornell voltage, and Gubner criterion. ResultsPatients with DM and MetS showed a significant leftward shift of the EA when compared with the control group. A modest but significant leftward shift of EA was also observed in both offspring groups. These EA and maximum QRS spatial vector magnitude changes were reflected in the individual leads of the 12-lead ECG. The prevalence of a positive diagnosis by accepted electrocardiographic criteria (ECG left ventricular hypertrophy) was low. ConclusionPatients with DM and MetS displayed significant changes in QRS complex that suggest depolarization sequence deterioration. Similar changes were observed also in the offspring of patients with DM and MetS, which suggests early subclinical cardiovascular damage. These findings have implications for prevention, early diagnosis, and treatment in the offspring of patients with DM and MetS.