Electrocardiographic Criteria For Left Ventricular Hypertrophy Research Articles

Prevalence, Performance and Predictors of Electrocardiographic Left Ventricular Hypertrophy in Male Black Athletes: A Retrospective Study

Introduction QRS voltages for electrocardiographic left ventricular hypertrophy (ECG-LVH) are more prominent in Black athletes than non-Black athletes. The underlying physiological relationships of ECG-LVH in BA remain enigmatic despite their greater predisposition to arterial hypertension. Objectives To determine the frequency of eight eponymous ECG-LVH criteria in male collegiate athletes in Nigeria; To determine the diagnostic performance of the most prevalent criteria; To determine the predictors of ECG-LVH. Methods 34 (thirty-four) athletes and 49 (forty-nine) non-athletic controls with normal electrocardiograms and echocardiograms were retrospectively recruited from an existing pre-participation screening cohort. They were all normotensive, non-obese and normoglycemic, and matched for age and body mass index (BMI). Results The four most frequent criteria were Sokolow-Lyon index (67.6% vs. 36.7%; χ2 = 7.7; p = .006), Romhilt’s criterion (52.9% vs. 8.2%; χ2 = 20.6; p < .001), Peguero-Lo Presti criterion (38.2% vs. 22.4%; χ2 = 2.43; p < .144), and Mazzoleni’s criterion (35.3% vs. 4.1%; χ2 = 13.95; p < .001). The sensitivity, specificity and accuracy of these criteria ranged between 23.8%–57.1%, 38.5%–53.9%, and 32.4%–50.0%, respectively. Athletic activity (OR = 4.49; 95% confidence interval, CI = 1.63–12.36; p = .004) and lower BMI (OR = 0.78; 95% CI = 0.63–0.97; p = .026) were independent predictors of ECG-LVH by the Sokolow-Lyon criterion. Conclusions Voltage ECG-LVH criteria all poorly predict the presence of echocardiographic LVH in young male Black athletes. However, the Sokolow-Lyon criterion seems to be associated with a benign cardio-metabolic profile in such athletes and appears hypothetically superior to other voltage criteria for identifying physiological cardiac remodeling in them. This hypothesis should be tested in future studies.

Improved evaluation of left ventricular hypertrophy using the spatial QRS-T angle by electrocardiography

Electrocardiographic (ECG) signs of left ventricular hypertrophy (LVH) lack sensitivity. The aim was to identify LVH based on an abnormal spatial peaks QRS-T angle, evaluate its diagnostic performance compared to conventional ECG criteria for LVH, and its prognostic performance. This was an observational study with four cohorts with a QRS duration < 120 ms. Based on healthy volunteers (n = 921), an abnormal spatial peaks QRS-T angle was defined as ≥ 40° for females and ≥ 55° for males. In other healthy volunteers (n = 461), the specificity of the QRS-T angle to detect LVH was 96% (females) and 98% (males). In patients with at least moderate LVH by cardiac imaging (n = 225), the QRS-T angle had a higher sensitivity than conventional ECG criteria (93–97% vs 13–56%, p < 0.001 for all). In clinical consecutive patients (n = 783), of those who did not have any LVH, 238/556 (43%) had an abnormal QRS-T angle. There was an association with hospitalization for heart failure or all-cause death in univariable and multivariable analysis. An abnormal QRS-T angle rarely occurred in healthy volunteers, was a mainstay of moderate or greater LVH, was common in clinical patients without LVH but with cardiac co-morbidities, and associated with outcomes.

Clinical Data, Chest Radiograph and Electrocardiography in the Screening for Left Ventricular Hypertrophy: The CAR2E2 Score.

Left ventricular hypertrophy (LVH) is associated with adverse clinical outcomes and implicates clinical decision-making. The aim of our study was to assess the importance of different approaches in the screening for LVH. We included patients who underwent cardiac magnetic resonance (CMR) imaging and had available chest radiograph in medical documentation. Cardiothoracic ratio (CTR), transverse cardiac diameter (TCD), clinical and selected electrocardiographic (ECG)-LVH data, including the Peguero-Lo Presti criterion, were assessed. CMR–LVH was defined based on indexed left ventricular mass-to-body surface area. Receiver operating characteristics analyses showed that both the CTR and TCD (CTR: area under the curve: [AUC] = 0.857, p < 0.001; TCD: AUC = 0.788, p = 0.001) were predictors for CMR–LVH. However, analyses have shown that diagnoses made with TCD, but not CTR, were consistent with CMR–LVH. From the analyzed ECG–LVH criteria, the Peguero-Lo Presti criterion was the best predictor of LVH. The best sensitivity for screening for LVH was observed when the presence of heart failure, ≥40 years in age (each is assigned 1 point), increased TCD and positive Peguero-Lo Presti criterion (each is assigned 2 points) were combined (CAR2E2 score ≥ 3 points). CAR2E2 score may improve prediction of LVH compared to other approaches. Therefore, it may be useful in the screening for LVH in everyday clinical practice in patients with prevalent cardiovascular diseases.

Regression of electrocardiographic left ventricular hypertrophy after transcatheter aortic valve replacement for aortic stenosis

Abstract Background The changes in electrocardiographic left ventricular hypertrophy (ECG-LVH) after transcatheter aortic valve replacement (TAVR) are not fully elucidated. Methods This retrospective single-center study investigated 156 patients who underwent TAVR for severe aortic stenosis. Twelve-leads ECGs obtained before and at 2 days and 1, 6 and 12 months after TAVR were analyzed. Patients with an implanted pacemaker, with a bundle branch block before or after TAVR or whose electrocardiogram at any measuring point was not available were excluded. As an assessment of ECG-LVH, Sokolow-Lyon voltage, Cornell voltage, Cornell product and Peguero–Lo Presti voltage were evaluated. Results Finally, 64 patients were included. Sokolow-Lyon voltage, Cornell voltage, Cornell product and Peguero–Lo Presti voltage significantly decreased between 1 and 6 months after TAVR compared to baseline. The prevalence of ECG-LVH criteria for each parameter decreased as well. QRS duration significantly decreased at 6 months after TAVR and the number of patients with strain pattern decreased significantly at 1 month when compared to baseline. When the patients were divided into two groups, those with and without ECG-LVH at baseline, ECG-LVH parameter values decreased significantly, especially in patients with ECG-LVH at baseline. Conclusion Regression of ECG-LVH after TAVR was demonstrated as per various criteria of ECG-LVH. The voltages and prevalence of ECG-LVH decreased significantly between 1 and 6 months after TAVR. Funding Acknowledgement Type of funding sources: None.

Visceral fat level correction of the left ventricular hypertrophy electrocardiographic criteria.

BackgroundLeft ventricular hypertrophy (LVH) is a well‐known risk factor for cardiovascular events. Even though there are many electrocardiographic (ECG) criteria for LVH, they still provide poor performance, especially among obese patients. The aim of this study was to examine whether adding visceral fat to ECG LVH criteria improves accuracy in the diagnosis.MethodsOne thousand seven hundred twenty two patients were included in the study. All patients underwent a complete physical examination, office blood pressure measurement, analysis of body composition, 12‐lead ECG, and M‐mode two‐dimensional echocardiography. Four standard ECG criteria for LVH were analyzed, including Cornell voltage criteria, Cornell duration criteria, Sokolow–Lyon voltage criteria, and Sokolow–Lyon product criteria. Adjustments of ECG LVH criteria were performed using visceral fat level (VFATL) and BMI. Transthoracic echocardiography was used as a reference method to compare the quality of ECG LVH criteria.ResultsMultivariate logistic regression models were created and revealed a significant increase of area under curve (AUC) after VFATL and BMI addition to ECG LVH criteria. Improvement of sensitivity at 90% specificity was observed in all created models. The odds ratio (OR) of the analyzed ECG criteria increased after adding VFATL and BMI to the models. Furthermore, ROC curves analysis exposed better characteristics in detecting LVH of VFATL‐adjusted criteria than BMI‐adjusted and unadjusted criteria.ConclusionsAdjusting ECG indexes to BMI or VFATL improves the sensitivity of LVH detection. VFATL‐corrected indexes are more sufficiently than BMI‐corrected. After advancements in indexes, both lean and morbidly obese individuals outcomes show a greater prevalence of correct LVH diagnosis.

The value of electrocardiogram and echocardiography to distinguish Fabry disease from sarcomeric hypertrophic cardiomyopathy

Screening for Fabry disease (FD) remains suboptimal in non-specialized centers. We aimed to evaluate the diagnostic value of electrocardiographic (ECG) scores of left ventricular hypertrophy (LVH) and the diagnostic value of a combined ECG and echocardiographic model for FD. We retrospectively reviewed the ECG and echocardiogram of 61 patients (age: 55.6 ± 11.5 years, 57% men) with FD and LVH, and compared them to 59 patients (age: 44.8 ± 18.3 years, 66% men) with sarcomeric hypertrophic cardiomyopathy (HCM). Six ECG criteria for LVH were specifically analyzed: – Sokolow-Lyon index, – Cornell voltage index 3) Gubner index, – Romhilt-Estes score, – Sokolow-Lyon voltage × QRS duration product, – Cornell voltage × QRS duration product. Right Bundle Branch Block (RBBB) was more frequent in FD (54% vs. 22%, P = 0.001). QRS duration, Gubner score, and Sokolov-Lyon product were significantly higher in FD. Maximal thickness wall (MTW) was higher in sarcomeric HCM group (21.9 ± 5.1 mm vs. 15.5 ± 2.9 mm in Fabry, P < 0.001). Indexed Valsalva sinus diameter was higher in patients with FD. After multivariable analysis RBBB, Sokolov-Lyon product, MTW and aortic diameter were independently associated with FD. A model including these 4 parameters yielded an area under the ROC curve of 0.918 [95% Confident Interval: 0.868–0.968] for FD. Our model combining easy-to-assess ECG and echocardiographic parameters may be helpful to improve screening and reduce diagnosis delay of FD.

Cornell voltage left ventricular hypertrophy predicts all-cause mortality better than Sokolow-Lyon voltage in patients with and without diabetes – data from 183,749 primary care ECGs

Abstract Background Cornell voltage criteria (CL) and Sokolow-Lyon criteria (SL) for electrocardiographic left ventricular hypertrophy (ECG-LVH) are well known predictors of cardiovascular outcome. However, their predictive value may differ according to patient type and remains to be further tested in diabetic mellitus (DM) patients. Purpose The present study aims to determine the prevalence of each ECG-LVH criteria and their respective predictive value in DM patients. Method A retrospective cohort study of individuals age &amp;gt;40 years with digital ECGs from primary care were collected during 2001 to 2011. Data on medication, comorbidity, and outcomes were collected from Danish nationwide registries. DM was defined if individuals were prescribed oral antidiabetics or insulin, if they were diagnosed with DM type I or II, or had a HbA1c&amp;gt;48 mmol/l. Cox multivariable analysis was used for estimating hazard ratio (HR) and 95% confidence intervals (95% CI) for all-cause mortality during follow-up of up to 17 years. Results Included were 183,749 individuals with a digital ECG collected in primary care. A total of 13,003 (7.1%) individuals had DM, they were older (65.8 vs. 61.3 years), had more myocardial infarction (16.1% vs. 5.2%), stroke (14.4% vs. 6.2%), hypertension (35.1% vs. 13.2%), CL LVH (8.0% vs. 5.6%) and more were males (53.3% vs. 45.3%) compared to the non-DM individuals (all p&amp;lt;0.001). CL identified a larger percentage of LVH in DM compared to non-DM individuals (8.0% vs. 5.6%, p&amp;lt;0.001), whereas SL identified similar percentage LVH in DM and non-DM individuals (8.5% vs. 8.1%, p=0.068). In multivariable adjusted analysis CL LVH remained strongly associated with all-cause mortality [HR 1.45 (95% CI: 1.42–1.48)] compared to SL LVH which found only a modest association [HR 1.06 (95% CI: 1.03–1.10)] (Figure 1). Of note, the association of CL LVH and all-cause mortality was even stronger than DM per se. There was no interaction with DM and either ECG LVH criteria (p&amp;gt;0.45). Conclusion Cornell Voltage Left Ventricular Hypertrophy is a strong predictor of mortality in patients with and without diabetes and an independent risk factor compared to hypertension and diabetes. The predictive value was substantially stronger than Sokolow-Lyon Voltage criteria for hypertrophy. Figure 1. LVH and all-cause mortality Funding Acknowledgement Type of funding source: None

Prognostic significance of body mass index-adjusted criteria for left ventricular hypertrophy.

Electrocardiographic left ventricular hypertrophy (ECG-LVH) is associated with both cardiovascular and all-cause mortality. Obesity attenuates the sensitivity of several ECG-LVH criteria, so body mass index (BMI) adjusted criteria have been developed. However, the prognostic significance of BMI-adjusted ECG-LVH criteria is not known. This analysis included 7812 participants (59.8±13.4years, 53% women, 50% non-Hispanic-whites) from the Third National Health and Nutrition Examination Survey. The Cornell criteria (R in aVL+S in V3≥2800µV in men or ≥2200µV in women) and Sokolow-Lyon criteria (S in V1+R in V5 or R in V6≥3500µV) criteria were used for LVH. To account for the effects of obesity, the BMI-adjusted Cornell criteria (product of R in aVL+S in V3 and BMI>60400µVkgm-2 ) and the BMI-adjusted Sokolow-Lyon criteria (add 400µV if overweight, add 800µV if obese) were used. Compared to traditional ECG-LVH criteria, more participants met criteria for ECG-LVH with BMI-adjusted Cornell voltage (9.9% vs 2.9%) and BMI-adjusted Sokolow-Lyon (13.1% vs 6.4%) criteria. In multivariable-adjusted Cox proportional hazards models, the BMI-adjusted Sokolow-Lyon criteria performed no better than traditional criteria (HR 1.18, 95% CI 1.06-1.32 for all-cause, HR 1.38, 95% CI 1.17-1.62 for cardiovascular mortality) and the BMI-adjusted Cornell voltage criteria attenuated the association with all-cause (HR 1.16, 95% CI 1.03-1.32) and cardiovascular mortality (HR 1.34, 95% CI 1.13-1.60). Despite potential improvements in the detection of LVH using BMI-adjusted ECG-LVH criteria, adjusting for BMI may result in the loss of prognostic information.

Diagnostic utility of the electrocardiographic left ventricular hypertrophy criteria in specific populations

Background Several electrocardiographic (ECG) criteria have been validated for the diagnosis of left ventricular hypertrophy (LVH); the majority in Caucasian subjects from Europe and North America. Diagnostic utility of ECG criteria to detect LVH has never been established in our population; nonetheless they are frequently used. Objective To evaluate the diagnostic utility of different LVH ECG criteria in a Northern Mexican population and to determine the effect of gender, age, body mass index (BMI), hypertension and ischaemic heart disease (IHD) on their performance. Methods We conducted an observational, case-control study in patients divided according to the presence of LVH in an echocardiogram (Echo). We calculated the accuracy, sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of 22 ECG criteria. Results Four hundred thirty-two patients were studied (202 had LVH). The Dalfó criterion (ECG18. SV3 + RaVL) had the best diagnostic performance with a Se of 56%, Sp of 71.3%, PPV 62.9%, NPV 65% and a diagnostic accuracy (95%CI) of 64.1% (59.5–68.6). This criterion had the highest accuracy in both genders, in all BMI, in older patients (>60 years) and in those with positive Echo ischaemic heart disease (IHD); it also performed well in patients with history of IHD and in hypertensive patients. VDP Cornell had the best accuracy in patients less than 60 years old, and in patients with non-ischaemic findings by Echo. Conclusions The Dalfó criteria had the overall best accuracy in the detection of LVH, and specific populations.

Prognostic value of left ventricular hypertrophy in hypertensive patients: A meta-analysis of electrocardiographic studies.

Electrocardiographic left ventricular hypertrophy (LVH) has been used to predict adverse outcomes in different clinical settings. This meta-analysis aimed to compare the prognostic value of different electrocardiographic criteria of LVH at baseline in hypertensive patients. A systematic literature search was conducted in PubMed and Embase databases until December 3, 2019. Cohort studies that reported the association of baseline electrocardiographic LVH (Sokolow-Lyon voltage, Cornell voltage or Cornell product) with all-cause mortality or major cardiovascular events in hypertensive patients were included. The prognostic value of LVH was expressed by the risk ratio (RR) with 95% confidence interval (CI). Nine studies involving 41870 hypertensive patients were identified. Comparison with those with and without LVH patients indicated that the pooled RR value of all-cause mortality was 1.30 (95% CI 1.01-1.66) for the Sokolow-Lyon voltage criteria, 1.33 (95% CI 1.20-1.47) for the Cornell voltage criteria, and 1.31 (95% CI 0.97-1.78) for the Cornell product criteria. In addition, the pooled RR of major cardiovascular events was 1.53 (95% CI 1.27-1.86) for the Sokolow-Lyon criteria and 1.46 (95% CI 1.22-1.76) for the Cornell voltage criteria, respectively. This meta-analysis suggests that different electrocardiographic criteria for detecting LVH at baseline differ in prediction of all-cause mortality in patients with hypertension. LVH detected by the Cornell voltage and Sokolow-Lyon criteria can independently predict the major cardiovascular events in hypertensive patients.

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

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

The diagnostic value of electrocardiographic criteria for left ventricular hypertrophy in essential arterial hypertension alone and in combination with coronary heart disease

Objective: to evaluate the diagnostic significance of the electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) in 12 leads in patients with essential arterial hypertension (AH) and in AH in combination with ischemic heart disease (IHD) compared with echocardiography (EchoCG) data. Materials and methods: ECG and EchoCG were carried out in 165 patients with AH (n = 139) and AH with concommitant IHD (n=26). Results: EchoCG signs of LVH ("EchoCG +") were detected in 72 (51,7%) patients with AH and in 12 (46,1 %) patients in AH + IHD. In the EchoCG + group the electrocardiographic signs of LVH (Sokolov-Lyon index, Cornell product, Cornell index) were determined in 37 (30,5 %) hypertensive patients and in no case in the AH + IHD group. In the "EchoCG-" group, electrocardiographic signs of LVH were determined in 8 hypertensive patients and two in the AH + CHD group. The use of additional voltage criteria for LVH in the frontal plane leads (RI &gt; 15 mm, R I + S III &gt; 25 mm, R aVL &gt; 12 mm) increased the detection of LVH from 30,5 % (n=22) to 51,3 % (n=37). The false negative ECG diagnosis of LVH was influenced by: positional features, interventricular conduction defect, metabolic disorders and high index body mass. Conclusion: The Sokolov-Lyon index, the Cornell index, the Cornell product have low sensitivity in the diagnosis of LVH (30,5 %). Adding the frontal plane leads voltage criteria for LVH may contribute to increase in electocardiographic LVH detection (51,3 %). The decrease in the sensitivity of the ECG criteria for LVH is mainly caused by the positional features of the heart, interventricular conduction defect, metabolic disorders and high index body mass.

Diagnostic Accuracy of Electrocardiographic Criteria for Left Ventricular Hypertrophy in Thalassemia Syndrome

We compared the diagnostic accuracy of electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) in 119 randomly selected from 400 patients with thalassemia major treated at the Department of Child Health, Medical School, University of Indonesia, Jakarta. Echocardiographically derived left ventricular hypertrophy (EchoLVH), both for body surface area (BSA)-indexed and height-indexed, served as the gold standard. There were 57 girls and 62 boys available, ranging in age from 5 to 27 years. ECG criteria for LVH was detected in 23 outof119 patients, while echo-LVH was detected in 47 patients if BSA-indexed LVH was used, or 22 patients if height-indexed LVH was used. The sensitivity and specificity of ECG-LVH were 25.5 and 84.7% respectively if BSA indexed LVH was used as gold standard, or 36.4% and 84.5%, respectively, when height indexed echo-LVH was used. It is concluded that ECG criteria for LVH has a low sensitivity and hjgh specificity in detecting increased left ventricular mass in children with thalassemia major.

Four ECG left ventricular hypertrophy criteria and the risk of cardiovascular events and mortality in patients with vascular disease.

The relation between different electrocardiographic left ventricular hypertrophy (ECG-LVH) criteria and cardiovascular risk in patients with clinical manifest arterial disease is unclear. Therefore, we determined the association between four ECG-LVH criteria: Sokolow-Lyon, Cornell product, Cornell/strain index and Framingham criterion; and risk of cardiovascular events and mortality in this population. Risk of cardiovascular events was estimated in 6913 adult patients with clinical manifest arterial disease originating from the Secondary Manifestations of ARTerial disease (SMART) cohort. Cox proportional regression analysis was used to estimate the risk of the four ECG-LVH criteria and the primary composite outcome: myocardial infarction (MI), stroke or cardiovascular death; and secondary outcomes: MI, stroke and all-cause mortality; adjusted for confounders. The highest prevalence of ECG-LVH was observed for Cornell product (10%) and Cornell/strain index (9%). All four ECG-LVH criteria were associated with an increased risk of the primary composite endpoint: Sokolow-Lyon (hazard ratio 1.37, 95% CI 1.13-1.66), Cornell product (hazard ratio 1.54, 95% CI 1.30-1.82), Cornell/strain index (hazard ratio 1.70, 95% CI 1.44-2.00) and Framingham criterion (hazard ratio 1.78, 95% CI 1.21-2.62). Cornell product, Cornell/strain index and Framingham criterion ECG-LVH were additionally associated with an elevated risk of secondary outcomes. Cardiovascular risk increased whenever two, or three or more ECG-LVH criteria were present concurrently. All four ECG-LVH criteria are associated with an increased risk of cardiovascular events. As Cornell/strain index is both highly prevalent and carries a high cardiovascular risk, this is likely the most relevant ECG-LVH criterion for clinical practice.

Peguero Electrocardiographic Left Ventricular Hypertrophy Criteria and Risk of Mortality.

Background: Peguero electrocardiographic left ventricular hypertrophy (ECG-LVH) criteria are newly developed criteria that have shown better diagnostic performance than the traditional Cornell-voltage and Sokolow-Lyon criteria. However, prediction of poor outcomes rather than detection of increased left ventricular mass is becoming the primary use for ECG-LVH criteria which requires investigating any new ECG-LVH criteria in terms of prediction.Aims: To examine the prognostic significance of the newly developed Peguero ECG-LVH criteria.Methods: We compared the prognostic significance of Peguero ECG-LVH with Cornell-voltage and Sokolow-Lyon ECG-LVH criteria in 7,825 participants (age 59.8 ± 13.4 years; 52.7% women) from the third National Health and Nutrition Examination Survey who were free of major intraventricular conduction defects. ECG-LVH criteria were derived from digital ECG tracings processed at a central core laboratory.Results: At baseline, ECG-LVH was detected in 11.8% by Peguero; in 4.3% by Cornell voltage and in 6.4% by Sokolow-Lyon. During a median follow up of 13.8 years, 2,796 all-cause mortality events occurred. In multivariable models adjusted for demographics and cardiovascular risk factors, presence of Peguero ECG-LVH was associated with increased risk of all-cause mortality [HR (95% CI): 1.29 (1.16, 1.44)]. This association was not significantly different from the associations of Cornell voltage-LVH or Sokolow-Lyon LVH with all-cause mortality [HR (95%CI): 1.32 (1.12, 1.55) and 1.24 (1.07, 1.43), respectively; p-values for comparisons of these HRs with the HR of Peguero ECG-LVH 0.817 and 0.667, respectively]. Similar patterns of associations were observed with cardiovascular, ischemic heart disease and heart failure mortalities.Conclusion: Peguero ECG-LVH is predictive of increased risk of death similar to the traditional ECG-LVH criteria.

Assessment of Novel Peguero-Lo Presti Electrocardiographic Left Ventricular Hypertrophy Criteria in a Large Asian Population: Newer May Not Be Better

BackgroundRecently, the novel Peguero-Lo Presti electrocardiographic criteria to diagnose left ventricular hypertrophy (LVH) were developed from Caucasian American population with a relatively high sensitivity. However, further validation on a large Asian population has never been conducted. Thus, this study was to test and validate the overall performance of this index in a general population from China. MethodsA total of 10,614 permanent residents ≥35 years of age were included in this study. All participants completed 12-lead electrocardiography and echocardiography at the same visit. A receiver-operating characteristic curve was used for comparing the performance of electrocardiographic indices in diagnosing echocardiographic LVH. ResultsThe Peguero-Lo Presti criteria had higher sensitivity but lower specificity than Cornell and Sokolow-Lyon voltage according to the recommended criteria. The area under the curve of this novel Peguero-Lo Presti voltage was lower than that of Cornell for predicting LVH defined by both left ventricular mass/body surface area (0.665 vs 0.699 in males; 0.689 vs 0.721 in females) and left ventricular mass/height2.7 (0.623 vs 0.681 in males; 0.642 vs 0.709 in females) (all Ps < 0.05). By changing cutoff values, Cornell voltage outperformed Peguero-Lo Presti whether to achieve a relatively high sensitivity or specificity. ConclusionsThe novel Peguero-Lo Presti voltage may not be a better screening tool for LVH in Asian population. In comparison with this new index, Cornell voltage could be a better screening test for LVH by changing its cutoff values to obtain maximum sensitivity.

Adding BMI to Electrocardiographic Criteria improves Accuracy of Predicting Left Ventricular Mass in Football Athletes

Electrocardiographic (ECG) measurements are commonly used to diagnose left ventricular (LV) hypertrophy in men, yet the validity of this practice has seldom been appraised in American-style football (ASF) athletes. PURPOSE: Evaluate the accuracy of five commonly used ECG criteria for LV hypertrophy – Murphy (AJC, 1984), Sokolow (AHJ, 1949), Gruber (Arch Intern Med, 1943), Cornell (Casale, JACC, 1985), and Cornell voltage-duration product (C-VDP) (Malloy, JACC, 1992) – to predict echocardiographically (ECHO) measured LV mass (LVM) in ASF athletes. METHODS: Resting12-lead ECG and ECHO procedures were performed on 62 collegiate ASF players first entering an NCAA Football Bowl Subdivision university; age=18±1 yr., ht=186±7 cm, wt=99.9±22.6 kg, BMI=28.6±5.0 kg·m2, and BSA=2.23±0.26 m2. Regression was used to predict ECHO-derived LVM and LVM/BSA from the five ECG criteria, and from the ECG criteria with BMI (+BMI) added to the model. RESULTS: Table (*p<0.01 for regression)Table: No title available.None of the ECG criteria alone were predictive of LVM or LVM/BSA in ASF athletes. Adding BMI to the regression significantly improved the predictive accuracy for LVM but not for LVM/BSA. CONCLUSION: ECG criteria alone are not useful in diagnosing LVH in ASF athletes. Our results suggest that adding demographic measures to the predictive model may improve diagnostic accuracy. Thus, new algorithms for evaluating LVM and LVH in ASF athletes should be explored using demographic, body habitus, cardiovascular, and other ECG criteria.

Prevalence of electrocardiographic left ventricular hypertrophy among patients with coronary artery disease and diabetes mellitus

Introduction. Electrocardiography (ECG) is a widely used non-invasive diagnostic method for assessment of patients with cardiovascular diseases. Numerous different electrocardiographic criteria exist for detection of left ventricular hypertrophy (LVH). LVH is an important risk factor in patients with coronary artery disease (CAD) or diabetes mellitus and its presence is associated with increased cardiovascular morbidity and mortality. The aim of this study was to evaluate the prevalence of the most frequently used electrocardiographic left ventricular hypertrophy (ECG-LVH) criteria among patients with CAD and diabetes. Methods. A cross-sectional, multicenter study was conducted in outpatient clinics across Poland. Family physicians performed physical examinations and collected relevant information about: onset of CAD and diabetes, presence and onset of hypertension, dyslipidemia, heart failure, diabetic complications, history of acute coronary syndrome and pharmacotherapy. In order to detect LVH, we used seven ECG criteria: 1) the Sokolow-Lyon voltage, 2) the Gubner voltage, 3) the criterion of the R wave amplitude on the leads V5–V6 and 4) aVL, 5) the gender specific Cornell voltage and 6) product, and 7) the Romhilt-Estes point score. Centralized manual assessment of the obtained ECG tracings were performed. Results. We enrolled 1001 patients (48.5% women, 51.5% men, mean age 65 ± 11 years) into the study. At least one ECG-LVH criterion was met in 20.0% (n = 200) of the study participants. The ECG-LVH diagnosis was the most common when using the Romhilt-Estes point score (n = 138; 13.8%). The corresponding prevalence rates for the Cornell voltage, the Cornell product, the R wave amplitude on the lead aVL, the Sokolow-Lyon voltage, the Gubner voltage and the R wave amplitude on the leads V5-V6 criteria were 5.5% (n = 55), 5.2% (n = 52), 3.2% (n = 32), 2.2% (n = 22), 1.9% (n = 19) and 1.3% (n = 13) respectively. Subsequently, the prevalence of the three most frequently used in clinical practice electrocardiographic criteria for LVH (the Sokolow-Lyon voltage, the Cornell voltage and the Romhilt-Estes point score) was analyzed. At least one of them was fulfilled in 185 ECGs. All three criteria at the same time were met only in 5 ECGs (2.7% of 185). Two and only one out of three criteria were fulfilled in 20 (10.8%) and 160 (86.5%) ECGs respectively. Conclusions. The co-occurrence of all assessed ECG-LVH criteria, including the three most frequently applied in clinical practice, is very low in diabetic CAD patients. The Romhilt-Estes point score identifies the highest number of ECG-LVH cases in this setting. However, it seems reasonable to use routinely several ECG criteria for detection of LVH. Further studies are needed to compare diagnostic values of ECG-LVH criteria with imaging methods and to assess prognostic values of various ECG-LVH criteria.

Early Systolic Dysfunction of Left Ventricular Myocardium Is Reflected On Electrocardiogram of Patients With Aortic Stenosis

to study relation between electrocardiographic (ECG) criteria of left ventricular hypertrophy (LVH) and parameters of tissue Doppler (TD) and LV strain in patients with aortic stenosis (AS) with preserved LV ejection fraction. We examined 80 patients with degenerative AS of all degrees of severity. Examination included history, blood serum cholesterol and creatinine, 12 lead ECG, routine echocardiography (EchoCG), TD, and LV global longitudinal peak strain (GLPS) in apical positions of 2-dimensional EchoCG. ECG criteria demonstrated low sensitivity relative to presence of real LVH. Average values of TD and (GLPS) were lowered in patients with AS. Correlation analysis revealed reverse relationship between TD and GLPX (<0.05). ROC-curve analysis showed very good quality of informativeness of the Cornell index and product for diagnosis of GLPX lowering below - 13%. ECG criteria of LVH poorly reflect real LVH but are markers of early systolic LV dysfunction.

Electrocardiographic Criteria for Left Ventricular Hypertrophy in Asians Differs from Criteria Derived from Western Populations—Community-based Data from an Asian Population

Electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH), such as the Cornell and Sokolow-Lyon voltage criteria were derived from Western populations. However, their utility and accuracy for diagnosing echocardiographic LVH in Asian populations is unclear. The objective of this study was to assess the accuracy of ECG criteria for LVH in Asians and to determine if alternative gender-specific ECG cut-offs may improve its diagnostic accuracy. ECG and echocardiographic assessments were performed on 668 community-dwelling Asian adults (50.9% women; 57 ± 10 years) in Singapore. The accuracy of ECG voltage criteria was compared to echocardiographic LVH criteria based on the American Society of Echocardiography guidelines, and Asian ethnicity and gender-specific partition values. Echocardiographic LVH was present in 93 (13.6%) adults. Cornell criteria had low sensitivity (5.5%) and high specificity (98.9%) for diagnosing LVH. Modified gender specific cut-offs (18 mm in women, 22 mm in men) improved sensitivity (8.8% to 17.5%, 0% to 14.7%, respectively) whilst preserving specificity (98.2% to 94.2%, 100% to 95.8%). Similarly, Sokolow-Lyon criteria had poor sensitivity (7.7%) and high specificity (96.1%) for diagnosing LVH. Lowering the cut-off value from 35 mm to 31 mm improved the sensitivity in women from 3.5% to 14% while preserving specificity at 94.2%. A cut-off of 36 mm was optimal in men (sensitivity of 14.7%, specificity of 95.5%). Current ECG criteria for LVH derived in Western cohorts have limited sensitivity in Asian populations. Our data suggests that ethnicity- and gender-specific ECG criteria may be needed.