Electrocardiographic Voltage Criteria Research Articles

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

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

PS-C27-7: ELECTROCARDIOGRAPHIC LEFT VENTRICULAR HYPERTROPHY CAN PREDICT FUTURE DECLINE OF RENAL FUNCTION IN GENERAL POPULATION

Objective: Electrocardiographic left ventricular hypertrophy (LVH) has been shown to be associated with future renal function decline in patients with chronic kidney disease. However, this association remains unclear in general population. We aimed to elucidate the association between baseline LVH on electrocardiogram and future renal function decline using health checkup data. Design and method: We used a dataset derived from the annual health-screening program from 2010 to 2019. Patients with baseline estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2 were excluded. LVH was determined by the electrocardiographic voltage criteria at baseline. Association between LVH and renal function outcomes, specifically ≧ 30% decline in eGFR from baseline, eGFR decline less than 60 ml/min/1.73m2 and 45 ml/min/1.73m2, were analyzed using multivariate Cox proportional hazard models. Results: Among total of 19,825 participants, 1,263 had LVH and 18,562 no LVH. LVH group was older and more male and current smokers, and to complicated with more hypertension, and higher systolic (136.7 ± 20.9 vs 123.7 ± 19.1 mmHg, P < 0.001) and diastolic blood pressure (81.8 ± 12.6 vs 74.6 ± 12.0 mmHg, P < 0.001). Baseline eGFR and HbA1c were comparable between the groups. Incidence of ≧ 30% eGFR decline was significantly higher in LVH group (P < 0.001, log-rank test). LVH was associated with ≧ 30% eGFR decline (HR 1.92, 95% CI 1.26–2.91, P = 0.002) and eGFR < 45 ml/min/1.73m2 (HR 3.12, 95% CI 1.54–6.35, P = 0.002) after adjustment. LVH was not associated with eGFR < 60 ml/min/1.73m2 in the overall population. However, when analyzed this association in subpopulation stratified by baseline SBP (< 140 and ≧ 140 mmHg), LVH was associated with eGFR < 60 ml/min/1.73m2 in persons with SBP ≧ 140 mmHg (HR 1.40, 95% CI 1.10–1.79, P = 0.007) but not in those with SBP < 140 mmHg (HR 0.88, 95% CI 0.68–1.14, P = 0.32) (P for interaction between LVH and baseline SBP = 0.005). Similarly, LVH was significantly associated with ≧ 30% eGFR decline and eGFR < 45 ml/min/1.73m2 in persons with SBP ≧ 140 mmHg but not in those with SBP < 140 mmHg, although the interaction between LVH and baseline SBP was not significant in these renal outcomes. Conclusion: Electrocardiographic LVH was independently associated with the rate of renal function decline among general population. The association between LVH and future renal function decline might be stronger in people with SBP ≧140 mmHg.

Electrocardiographic Diagnosis of Hypertrophic Cardiomyopathy in the Pre- and Post-Diagnostic Phases in Children and Adolescents.

The usefulness of electrocardiographic (ECG) voltage criteria for diagnosing hypertrophic cardiomyopathy (HCM) in pediatric patients is poorly defined.Methods and Results:ECGs at the 1st grade (mean [±SD] age 6.6±0.3 years) were available for 11 patients diagnosed with HCM at around the 7th grade (13.2±0.3 years). ECGs were available for another 64 patients diagnosed with HCM in the 1st (n=15), 7th (n=32), and 10th (n=17) grades. Fifty-one voltage criteria were developed by grade and sex using 62,841 ECGs from the general population. Voltage criteria were set at the 99.95th percentile (1/2,000) point based on the estimated prevalence of childhood HCM (2.9 per 100,000 [1/34,483]) to decrease false negatives. Conventional criteria were from guidelines for school-aged children in Japan. Of 11 patients before diagnosis, 2 satisfied conventional criteria in 1st grade; 5 (56%) of the remaining 9 patients fulfilled 2 voltage criteria (R wave in limb-lead I [RI]+S wave in lead V3 [SV3] and R wave in lead V3 [RV3]+SV3). Robustness analysis for sensitivity showed RV3+SV3 was superior to RI+SV3. For all patients after diagnosis, RI+SV4 was the main candidate. However, conventional criteria were more useful than voltage criteria. Early HCM prediction was possible using RV3+SV3 in >50% of patients in 1st grade. Voltage criteria may help diagnose prediagnostic or early HCM, and prevent tragic accidents, although further prospective studies are required.

Electrocardiographic voltage criteria in patients with hypertrophic cardiomyopathy.

Several ECG voltage criteria have been proposed for the diagnosis of left ventricular hypertrophy (LVH). Notably, ECG criteria have been historically validated in concentric LVH but not in hypertrophic cardiomyopathy (HCM), wherein the hypertrophy pattern is typically asymmetric. The aim of our study was to evaluate the performance of ECG voltage criteria for LVH diagnosis in the HCM population. The electrocardiograms of 92 HCM patients and 41 sex- and age-matched controls were evaluated with the most frequently used ECG voltage criteria for LVH diagnosis. Cardiac magnetic resonance (MRI) was performed in HCM and controls in order to quantify LVH and its distribution. In the HCM population, the maximal diagnostic accuracy was achieved by Amplitude total and Amplitude total product criteria (58% for both), while the Cornell Voltage best performed in septal HCM (62%), the Sokolov in aVL and Gubner criteria in apical HCM (79% for both) and the Cornell Voltage and Product in anterior HCM (86% for both). All the ECG voltage criteria showed a poor correlation with left ventricular mass and maximal thickness measured by cardiac MRI. In our study, only a few ECG voltage criteria used for the detection of LVH in clinical practice showed an acceptable performance in the HCM population. Further studies are needed to clarify the role of ECG for LVH detection in HCM patients.

An Electrocardiographic System With Anthropometrics via Machine Learning to Screen Left Ventricular Hypertrophy among Young Adults.

The prevalence of physiological and pathological left ventricular hypertrophy (LVH) among young adults is about 5%. A use of electrocardiographic (ECG) voltage criteria and machine learning for the ECG parameters to identify the presence of LVH is estimated only 20-30% in the general population. The aim of this study is to develop an ECG system with anthropometric data using machine learning to increase the accuracy and sensitivity for a screen of LVH. In a large sample of 2,196 males, aged 17–45 years, the support vector machine (SVM) classifier is used as the machine learning method for 31 characteristics including age, body height and body weight in addition to 28 ECG parameters such as axes, intervals and voltages to link the output of LVH. The diagnosis of LVH is based on the echocardiographic criteria for young males to be 116 gram/meter2 (left ventricular mass (LVM)/body surface area) or 49 gram/meter2.7 (LVM/body height2.7). On the purpose of increasing sensitivity, the specificity is adjusted around 70-75% and all data tested in proposed model reveal high sensitivity to 86.7%. The area under curve (AUC) of the Precision-Recall (PR) curve is 0.308 in the proposed model which is better than 0.109 and 0.077 using Cornell and Sokolow-Lyon voltage criteria for LVH, respectively. Our system provides a novel screening tool using age, body height, body weight and ECG data to identify most of the LVH among young adults. It provides a fast, accurate and practical diagnosis tool to identify LVH.

Validity of electrocardiographic criteria for increased left ventricular mass in young patients in the general population.

AIMTo investigate validity of electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) in young adults.METHODSRetrospectively, echocardiograms showing LVH and concomitant electrocardiograms were collected in patients 18 to 39 years old. A control group of patients without LVH was collected. Using echocardiogram as the gold standard, electrocardiograms were analyzed using common voltage criteria.RESULTSStudy included 100 subjects (52% male, mean age = 28 ± 6.8 years, 96% Hispanic or African-American) with 50% LVH prevalence. Sensitivity and specificity for Sokolow-Lyon criteria were 24% (95%CI: 13.5%-38.4%) and 88% (95%CI: 74.9%-95%). For Cornell criteria, sensitivity was 32% (95%CI: 19.9%-46.8%) and specificity 98% (95%CI: 87.9%-99.8%). For R in aVL criteria, sensitivity was 12% (95%CI: 4.9%-25%) and specificity 100% (95%CI: 91.1%-100%).CONCLUSIONIn young adults common ECG voltage criteria have low sensitivities and high specificities similar to other age groups. Low sensitivities preclude these ECG criteria from serving as effective screening tests.

Does Ecg Predict Cardiac Hypertrophy In American-style Football Athletes?

The accurate and cost effective identification of left ventricular (LV) hypertrophy is clinically relevant due to its association with cardiac mortality in the general population. PURPOSE: To determine if electrocardiographic (ECG) voltage criteria predicts LV mass measured with cardiac ultrasound in collegiate American-style football (ASF) players. METHODS: Over a 3-year period, standard resting, supine 12-lead ECG and echocardiographic (ECHO) procedures were performed on 76 collegiate ASF players first entering an NCAA Football Bowl Subdivision university as part of their preparticipation physical exams. Player demographics were: age=18±1 yr., height=186±7 cm, weight=100.1±22.0 kg, BMI=28.6±5.0 kg·m2, and BSA=2.24±0.25 m2 . Linear regression was used to predict ECHO-derived LV mass and LV mass/BSA index from ECG precordial-lead voltage criteria [sum largest S (V1 or V2) + R (V5 or V6) ≥ 35 mm]. RESULTS: ECG voltage criteria did not significantly (p > 0.05) predict ECHO LV mass (LV mass = -0.12x + 216.94, r = 0.024, R2 = 0.0006), or LV mass/BSA index (LV mass/BSA = 0.3063x + 81.951, r = 0.17, R2 = 0.0244). CONCLUSION: ECG precordial lead voltage was not clinically useful in diagnosing ECHO-derived LV hypertrophy in our sample of first-year collegiate ASF players. We suggest that new and more accurate algorithms for evaluating LV hypertrophy in ASF athletes be explored, possibly using demographic, body habitus, cardiovascular, and other ECG criteria.

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.

Correlation of Precordial Voltages to Left Ventricular Mass on Echocardiogram in Adolescent Patients With Hypertrophic Cardiomyopathy Compared With that in Adolescent Athletes

Electrocardiograms continue to be part of screening programs for athletes and familial hypertrophic cardiomyopathy (HC). Whether electrocardiographic (ECG) findings of left ventricular (LV) hypertrophy can distinguish between healthy populations and those with HC remains unclear. We sought to (1) analyze the relation between ECG voltage and LV mass in patients with HC and (2) evaluate ECG characteristics of patients with phenotypical HC. Retrospective cohort of patients with HC aged 13 to 18 years. Relation between ECG voltages (RV6, SV1, and RV6 + SV1) and echocardiogram measurements of LV mass was investigated using smoothing splines to display relations and compared with those in a prospectively obtained population of adolescents. Frequency of abnormal LV voltages and nonvoltage ECG changes (Q waves, T-wave changes, and ST changes) were analyzed for association with HC. Fifty-three patients with HC (72% men) were age and gender matched to 104 control patients. Smoothing splines demonstrated that parabolic rather than linear relations existed between LV mass and SV1, RV6, and RV6 + SV1 in patients with HC and not the control cohort. LV hypertrophy by ECG voltage criteria was present in 34% of patients with HC and associated with poor sensitivity (29%). In patients with HC, 56% demonstrated nonvoltage ECG abnormalities and were associated with improved sensitivity (68%) and high specificity (94%). In conclusion, there is a parabolic relation between LV voltages and LV mass in adolescents with HC that may lead to "pseudonormalization." Voltage abnormalities were associated with poor sensitivity, whereas nonvoltage criteria were associated with improved sensitivity with high specificity.

Accuracy and prognostic significance of electrocardiographic markers of left ventricular hypertrophy in a general population

We assessed the value of three electrocardiographic (ECG) voltage criteria in detecting left ventricular hypertrophy (LVH) and in predicting cardiovascular events and all-cause mortality in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) population. At entry, 1549 individuals (age 50 ± 13 years, 50.5% men) underwent diagnostic tests including laboratory investigations, 24-h ambulatory blood pressure monitoring, and standard ECG and echocardiography. The sensitivity of ECG criteria for LVH was lowest for Sokolow-Lyon voltage (1.5 and 0.78%), intermediate for Cornell voltage (20.5 and 19.0%), and highest for RaVL wave amplitude (26.0 and 36.2%), independently of whether left ventricular mass was indexed to body surface area or height, respectively. After adjustment for age, sex, night-time SBP, low-density lipoprotein and high-density lipoprotein cholesterol, serum glucose, BMI, smoking, and previous cardiovascular events, only Cornell voltage index [hazard ratio for a 0.1 mV increase: 1.050, 95% confidence interval (CI): 1.017-1.083, P < 0.003] predicted an increased risk of cardiovascular events as well as all-cause mortality. Furthermore, when the categorical relationship between ECG-graphic LVH and cardiovascular outcomes was investigated in multiple models, only LVH identified by the Cornell voltage index remained an independent predictor of cardiovascular events (hazard ratio = 2.466, CI 1.459-4.168, P = 0.0008) and all-cause deaths (hazard ratio = 2.984, CI 1.380-6.449, P = 0.005). Despite the limited sensitivity of ECG voltage criteria in detecting LVH, our results show that Cornell voltage index may improve cardiovascular risk stratification in a general population independently of several confounding factors.

The strain pattern, and not Sokolow–Lyon electrocardiographic voltage criteria, is independently associated with anatomic left ventricular hypertrophy

Although obesity and chest-wall thickness influence the Sokolow-Lyon electrocardiographic (ECG) voltage criteria and strain pattern, these factors have not been taken into account in previous studies that evaluate the relationship between the ECG criteria and anatomic left ventricular hypertrophy (LVH). The introduction of multislice computed tomography (MSCT) has enabled assessment of not only coronary artery stenoses but also left ventricular volume and mass, left atrial volume, and chest-wall thickness. We hypothesized that evaluating the relation between the ECG voltage criteria or strain pattern and the aforementioned factors using MSCT would be highly valuable. The study population consisted of 93 patients who required MSCT angiography. The Sokolow-Lyon voltage and strain patterns were determined to detect anatomic LVH, which was defined as increased left ventricular mass. The Sokolow-Lyon voltage criteria, as an indicator of anatomic LVH, had a sensitivity of 57 %, specificity of 67 %, positive predictive value of 36 %, and negative predictive value of 82 %. By contrast, the strain pattern had a sensitivity of 65 %, specificity of 87 %, positive predictive value of 63 %, and negative predictive value of 88 %. Multivariate analysis revealed that the strain pattern was associated with the presence of anatomic LVH, whereas the Sokolow-Lyon voltage was not. This MSCT study demonstrated that even after removing the effects of various factors, the strain pattern remained associated with the presence of anatomic LVH, in contrast to the Sokolow-Lyon voltage.

Comparative study of ECG and echocardiographic parameters indicative of cardiac hypertrophy in athletes

The identification of left ventricular hypertrophy (LVH) through electrocardiographic voltage criteria has been widely studied in patients. However, their validity in “athlete’s heart” remains quite unknown. The aim of this study was to evaluate the most common electrocardiographic indices indicative of LVH compared to the known echocardiographic ones in athletes. The study group comprised 150 male adult competitive athletes (group A) and 50 sedentary participants (group B). Thirteen accepted electrocardiographic voltage criteria indicative of LVH were calculated and correlated with the common echocardiographic indices of left ventricular mass (LVM). Nine of the 13 ECG voltage criteria were significantly increased in athletes compared to controls. Statistically, the Sokolow–Lyon index, which is the most commonly used voltage index was found to be affected by the body mass index (10.7 %, p < 0.05), the group (7.3 %, p < 0.05) and systolic blood pressure (4.5 %, p < 0.05) in total variance of 16.6 % (p < 0.05). No electrocardiographic voltage criterion was significantly correlated with any echocardiographic index, except for the Cornell index that was correlated with end-diastolic volume index (r = 0.29, p < 0.05) and the Sokolow index (V6) with LVMI (r = 0.26, p < 0.05) in group A. We suggested that ECG voltage indices should not be considered valid when assessing LVH in athletes. Thus, the echocardiographic study is preferable in studying training-induced structural cardiac changes.

Influence of Dietary Sodium Modulation on Electrocardiographic Voltage Criteria for Left Ventricular Hypertrophy in Normotensive Individuals

ObjectiveDietary sodium intake and left ventricular hypertrophy (LVH) on electrocardiogram (ECG) are both independent determinants of cardiovascular risk. Prior studies demonstrated that acute dietary sodium modulation significantly altered LVH-specific ECG...

Prognostic significance of baseline and serial changes in electrocardiographic strain pattern in resistant hypertension

The prognostic importance of serial changes in electrocardiographic strain pattern of lateral ST-depression and T-wave inversion is unclear. The objective was to evaluate the significance of baseline and serial changes in strain pattern as predictors of cardiovascular morbidity and mortality in patients with resistant hypertension. At baseline and during follow-up, 532 resistant hypertensive patients had the presence of strain pattern examined on 12-lead ECGs. Other clinical laboratory, echocardiographic and ambulatory blood pressure data were obtained. Primary endpoints were a composite of total cardiovascular events and mortality. Strokes and coronary heart disease events were secondary endpoints. Multiple Cox regression assessed the associations between strain pattern and subsequent endpoints. At baseline, 115 patients (21.6%) presented the strain pattern and during follow-up, 17 patients regressed and 22 developed new strain pattern. After a median follow-up of 4.8 years, 69 patients died, 46 from cardiovascular causes; and 107 cardiovascular events occurred, 44 strokes and 42 coronary heart disease events. After adjustment for several cardiovascular risk factors, including time-varying ambulatory blood pressures and electrocardiographic voltage criteria of left ventricular hypertrophy, the persistence or development of strain during follow-up was a predictor of the composite endpoint (hazard ratio 1.97, 95% confidence interval 1.19-3.25), all-cause mortality (hazard ratio 1.99, 95% confidence interval 1.10-3.61) and of stroke (hazard ratio 3.09, 95% confidence interval 1.40-6.81). The combination of strain pattern and left ventricular hypertrophy voltage criteria improved stratification of cardiovascular risk. Serial changes in electrocardiographic strain pattern during follow-up predict cardiovascular morbidity and mortality in resistant hypertensive patients. Regression or prevention of the strain pattern during antihypertensive treatment may be a therapeutic goal to improve prognosis.

Morbilidad y mortalidad cardiovascular y criterios electrocardiográficos de hipertrofia ventricular izquierda en pacientes hipertensos en atención primaria

Fundamentals and objective Electrocardiographic voltage criteria are the preferred method for diagnosis of left ventricular hypertrophy (LVH) in Primary Health Care (PHC). Several of these have been described as major adverse cardiovascular events (MACE) predictors. The aim of this study was to analyse the relationship between MACE occurrence in a cohort of hypertensive subjects in PHC and different electrocardiographic criteria recorded. Patients and methods 265 hypertensive subjects attending PHC were randomly selected and followed up for 12 years. Standard 12-lead electrocardiograms were recorded at the beginning of the study. The occurrence of ischemic heart disease, heart failure, stroke, peripheral vascular disease, arrhythmia or cardiovascular death was considered as MACE. Electrocardiographic voltage criteria recorded were: Sokolow-Lyon, Minnesota code 3.1, Gubner and Ungerleider, Cornell voltage and Schillaci and Dalfó modifications. Data were analyzed using the life-table method and Cox regression models. Results 14,3% of patients lost to follow-up showed no differences in baseline characteristics from the rest of the cohort. The median follow-up was 10.1 years (IQR: 5.8–12.0). The cumulative survival rate was 53.5% (95% CI, 45.7–61.3%). The incidence of MACE was 5.85 (95% CI, 4.73–6.97) per 100 hypertensive patients-year. In the multivariate analysis none of the ECG criteria showed statistical association with the occurrence of MACE. Conclusions No association has been found between different electrocardiographic LVH criteria and the incidence of MACE in a cohort of hypertensive patients followed-up in a PHC setting for 12 years.

TARGET ORGAN DAMAGE IN HYPERTENSIVE PATIENTS IN RELATION TO CLINIC, HOME AND AMBULATORY BLOOD PRESSURE MEASUREMENTS: PP.25.17

Objective: This study compared the cardiovascular status of hypertensive patients in relation to blood pressure (BP) measurements in the clinic (CBP), at home (HBP) and with ambulatory (ABP) monitoring. Design and Method: Three hundred hypertensive individuals, mean age (60 ± 11) years, 170 males, 213 under drug treatment, were included. CBP was measured in 3 visits at least 1 week apart, HBP for 4 consequent workdays with duplicate morning and evening measurements and ABP for 24 hours. Cardiovascular target organ damage (TOD) was assessed by Sokolow-Lyons electrocardiographic voltage criteria and prediction of 10-year risk for fatal cardiovascular disease was calculated using SCORE tables for low risk European region. Results: The correlation coefficients of Sokolow-Lyons criteria with CBP were 0.10/-0.06 (systolic/diastolic), with HBP 0.31***/0.17**, and with ABP mean 0.19***/0.10, daytime 0.19***/0.07, nighttime 0.17**/0.10, early morning first BP 0.13*/-0.02. Comparison of the relationship of HBP versus other BP measurements with Sokolow-Lyons criteria was significant for CBP and first morning BP only. The correlation coefficients of SCORE risk with CBP were 0.09/-0.02, with HBP 0.17**/0.10, and with ABP mean 0.13*/0.08, daytime 0.11/0.04, nighttime 0.18**/0.15**, early morning first BP 0.16**/0.09. There was no significant statistical difference between the correlation coefficients of HBP versus other BP measurements in relation to SCORE risk. * P < 0 .05; ** P < 0.01; *** P < 0.001. Conclusions: In hypertensive patients, CBP was not correlated significantly with LVH electrocardiographic Sokolow-Lyons voltage criteria and SCORE risk, in comparison to the other BP measurement methods, HBP and ABP.

Sensitivity and Specificity of Frequently Used Electrocardiographic Criteria for Left Ventricular Hypertrophy in Patients with Anterior Wall Myocardial Infarction

Electrocardiographic left ventricular hypertrophy (LVH) strongly predicts mortality in patients with myocardial infarction (MI). However, the validity of LVH voltage criteria in this context has not been assessed. Reviewing the coded database of echocardiographic studies performed at one institution, we performed a retrospective analysis of 49 patients who had anterior akinesis on the echocardiogram and anterior wall MI on the electrocardiogram. Results showed that, compared with the sensitivities and specificities of the electrocardiographic voltage criteria in historical cohorts, Cornell criteria were less sensitive and specific for the diagnosis of LVH in patients with anterior wall MI. The sensitivity was reduced in the presence of an associated lateral wall MI, and the specificity was reduced in the absence of a lateral wall MI (overall sensitivity in case of anterior wall MI, with or without an associated lateral wall MI, 21% vs 41%, P = 0.049; overall specificity 84% vs 98%, P = 0.003). All criteria, except for S in V1 + R in V5 or V6 >3.5 mV, had a significantly reduced specificity in the case of anterior wall MI not associated with lateral wall MI, and all criteria, except for R in V6 > R in V5, had reduced sensitivity in the presence of a lateral wall MI. In conclusion, anterior wall MI reduces the sensitivity and the specificity of the most commonly used LVH voltage criteria.

Diagnostic value of different electrocardiographic voltage criteria for hypertrophic cardiomyopathy in young people

Differences in the diagnostic value of various electrocardiographic (ECG) voltage indices for hypertrophic cardiomyopathy (HCM) are yet to be elucidated. The objective of this study was to examine the strongest predictor within ECG voltage criteria for left ventricular hypertrophy (LVH) in HCM to be applied in cardiovascular examination of young people. The electrocardiograms of 36 healthy individuals with high voltages, mimicking HCM (i.e., false-positive), were statistically compared with those of 30 subjects with an ECG diagnosis of HCM. The most striking ECG voltages observed in HCM patients were those included in leads DI, aVL (R wave) and V3 (S wave) (P<0.001), typically present in the Cornell, Gubner and Lewis voltage criteria. In a stepwise logistic regression analysis model, these indices were the most significant predictors of HCM (P<0.001, P<0.027 and P<0.006, respectively). The combination of Cornell (RaVL+SV3>2.8 mV in men and>2.0 mV in women) with Lewis (RI+(''')SIII-RIII-SI>1.7 mV) or Gubner-Ungerleider (RI+(''')SIII>2.5 mV) indices displayed the highest net sensitivity (80.0% and 76.7%, respectively) while retaining excellent specificity (88.9% and 91.6%, respectively). In conclusion, the combination of the Cornell and the Lewis or Gubner voltage criteria showed the greatest net sensitivity and specificity for the LVH diagnosis of HCM in a cardiovascular examination conducted in young people.

Electrocardiographic prediction of left ventricular geometric patterns in patients with essential hypertension

Background The present study sought to determine the diagnostic value of electrocardiographic voltage criteria in predicting geometry patterns in patients with essential hypertension. Methods Patients with essential hypertension ( n = 125) according to left ventricular mass index and relative wall thickness as determined by echocardiography were assigned in the following groups: normal geometry (N, n = 50), concentric remodeling (CR, n = 12), concentric hypertrophy (CH, n = 28) and eccentric hypertrophy (EH, n = 35). Each patient underwent 12-lead ECG followed by determination of conventional voltage criteria as well as peak to peak QRS lengths in each lead. Results Voltage criteria such as Sokolow–Lyon, Cornell, Cornell product > 2440, D1R + D3S > 25 mm, and AVL R > 11 mm could not significantly predict and discriminate geometric patterns of LVH. However, they all were very specific (range 97–100%) and showed very high positive predictive values (range 94–100%) for detecting abnormal geometry. DI peak > 12 mm had a sensitivity 61%, specificity 67%, accuracy 63%, positive predictive value 81%, and negative predictive value 42% in predicting to differentiate CH from CR. Sum of the calculated values from the peak of the R to the nadir of the S wave in all limb leads > 60 mm had sensitivity 68%, specificity 75%, accuracy 70%, positive predictive value 86% and negative predictive value 50% in predicting to differentiate CH from CR. Conclusions Conventional ECG voltage criteria could not significantly discriminate specific geometry patterns observed in patients with essential hypertension.

Sex Differences in the Relationships Between Electrocardiographic Abnormalities and the Extent of Left Ventricular Hypertrophy by Echocardiography

Several criteria have been proposed for the electrocardiographic diagnosis of left ventricular hypertrophy (LVH). However, their diagnostic accuracy is questionable. Furthermore, the diagnostic accuracy of abnormalities in ST-T patterns for LVH is known to be uncertain, especially in women. We examined the relationship between electrocardiographic abnormalities and the extent of LVH. We studied 76 men and 48 women who satisfied electrocardiographic voltage criteria for LVH (RV(5) or RV(6)> or = 2.6 mV, SV(1) + RV(5) or SV(1) + RV(6)> or = 3.5 mV). They were classified into three groups based on ST-T pattern: normal, early strain, and strain. We defined echocardiographic evidence of LVH as an LV wall thickness > or = 12 mm. LVH was identified by echocardiography in 55.3% of men and in 47.9% of women. In strain and early strain groups, the prevalence of echocardiographic LVH was significantly higher in men than in women (strain group: 100 vs 75%, P < 0.05, early strain group: 81.8 vs 42.1%, P < 0.05), it did not differ significantly between men and women in normal group. In men, QRS voltage values were significantly correlated with echocardiographic indices. In group strain of men, significant good correlations were observed between QRS voltage values and echocardiographic indices. However, in women, there were no significant correlation between QRS voltage values and echocardiographic indices even in strain group. The combined criteria of both QRS voltage and ST-T classification could provide a greater accuracy in diagnosing LVH compared to the criteria using QRS voltage alone in men rather than in women.