Screening For Left Ventricular Hypertrophy Research Articles

The use of echocardiography compared to electrocardiogram when screening for left ventricular hypertrophy in hypertensive patients: A cross-sectional study.

Left ventricular hypertrophy (LVH) is often used as an indicator to assess hypertension-mediated organ damage (HMOD), alongside hypertensive retinopathy (HR) and nephropathy. Assessment of HMOD is crucial when making decisions about treatment optimization. Despite longstanding debate over its reliability to detect LVH, it is common practice to perform an electrocardiogram (ECG) instead of directly assessing left ventricular mass with echocardiography. In this study, the presence of LVH was evaluated using both ECG and echocardiography among consecutive patients suspected of therapy-resistant hypertension or secondary hypertension in the outpatient clinic of the Department of Internal Medicine at the Diakonessen Hospital, Utrecht, the Netherlands, between July 15, 2017, and July 31, 2020. The primary endpoints were the specificity and sensitivity of ECG as a diagnostic tool for LVH, with echocardiography serving as the reference method. Among the 329 participants, we identified 70 individuals (21.3%) with true LVH based on echocardiography. The ECG displayed a sensitivity of 47.9% and a specificity of 75.3%. Moreover, the area under the receiver operating characteristics curve was 0.604. In conclusion, ECG demonstrates limited value in identifying LVH. Considering the importance of accurately assessing HMOD for treatment optimization of hypertension, the role of ECG as a diagnostic tool for LVH is, therefore, questionable. Instead, we recommend employing standard echocardiography as a more reliable diagnostic.

CoAt-Mixer: Self-attention deep learning framework for left ventricular hypertrophy using electrocardiography.

Left ventricular hypertrophy is a significant independent risk factor for all-cause mortality and morbidity, and an accurate diagnosis at an early stage of heart change is clinically significant. Electrocardiography is the most convenient, economical, and non-invasive method for screening in primary care. However, the coincidence rate of the actual left ventricular hypertrophy and diagnostic findings was low, consequently increasing the interest in algorithms using big data and deep learning. We attempted to diagnose left ventricular hypertrophy using big data and deep learning algorithms, and aimed to confirm its diagnostic power according to the differences between males and females. This retrospective study used electrocardiographs obtained at Yonsei University Wonju Severance Christian Hospital, Wonju, Korea, from October 2010 to February 2020. Binary classification was performed for primary screening for left ventricular hypertrophy. Three datasets were used for the experiment: the male, female, and entire dataset. A cutoff for binary classification was defined as the meaningful as a screening test (<132 g/m2 vs. ≥132 g/m2, <109 g/m2 vs. ≥109 g/m2). Six types of input were used for the classification tasks. We attempted to determine whether electrocardiography had predictive power for left ventricular hypertrophy diagnosis. For the entire dataset, the model achieved an area under the receiver operating characteristic (AUROC) curve of 0.836 (95% CI, 0.833-838) with a sensitivity of 78.37% (95% CI, 76.79-79.95). For the male dataset, the AUROC was 0.826 (95% CI, 0.822-830) with a sensitivity of 76.73% (95% CI, 75.14-78.33). For the female dataset, the AUROC was 0.772 (95% CI, 0.769-775) with a sensitivity of 72.90% (95% CI, 70.33-75.46). Our model confirmed that left ventricular hypertrophy can be classified to some extent using electrocardiography, demographics, and electrocardiography features. In particular, a learning environment that considered gender differences was constructed. Consequently, the difference in diagnostic power between men and women was confirmed. Our model will help patients with suspected left ventricular hypertrophy to undergo screening tests at a low cost. In addition, our research and attempts will show the expected effect that gender-consideration approaches can help with various currently proposed diagnostic methods.

Survival and Analysis of Predictors of Mortality in Patients Undergoing Hemodialysis in a Rural Hospital in Puducherry, India: A Retrospective Cohort Study

Background: Despite the advent of dialysis technology, the survival of patients on hemodialysis (HD) is not encouraging. There is little information available regarding the prognostic factors of HD, its population characteristics, or outcomes in India. Objectives: We attempted to describe the profile of patients on HD, estimate the mean days of their survival and to determine the various factors associated with their survival. Materials and Methods: It was a retrospective cohort study conducted on patients who were on maintenance HD, registered during the five-year period between 1st January 2014 and 31st December 2018 in a tertiary care teaching hospital in Rural Puducherry, South India. Demographic, hematological, biochemical, electrocardiographic, echocardiographic parameters and death during follow-up were extracted from the dialysis database after de-identification. The survival rate was calculated using Kaplan- Meir Curves and Cox Regression analysis was done to estimate the adjusted hazard ratio. Results: The median survival of the 229 eligible patients on HD was 819 days. Cardiac pathology accounted for 25.7% of those deaths and 33.9% was sudden death. Adjusted Cox proportional model showed the presence of Left Ventricular Hypertrophy (LVH) (HR: 78.1), increase in phosphorus (HR: 1.26), decrease in haemoglobin (HR: 0.78), and decrease in serum albumin (HR: 0.52) were significant bad prognostic factors. Conclusion: Screening for LVH, anemia, hypoaluminemia and hyperphosphatemia amongst HD patients and managing them to prevent these bad prognostic factors has the potential to improve their survival.

Value of Monocyte to High-Density Lipoprotein Cholesterol Ratio in Screening of Left Ventricular Hypertrophy in Young and Middle-Aged Patients With Essential Hypertension

Abstract Background To investigate the relationships of monocyte to high-density lipoprotein cholesterol (HDL-C) ratio (MHR) with left ventricular hypertrophy (LVH) in young and middle-aged patients with essential hypertension (EH). Methods A retrospective analysis was performed on clinical data of 294 young and middle-aged patients with EH (aged from 18 to 65 years old). According to the left ventricular mass index (LVMI), the patients were divided into LVH (n = 98) and non-LVH (n = 196) groups. The data on echocardiography, routine blood test, biochemical examination, and so on were collected in all subjects, then LVMI and MHR were calculated. The association between MHR and hypertensive LVH was analyzed by correlation and binary logistic regression analyses. The receiver operating characteristic curve (ROC) was used to determine the predict value of MHR. Results MHR was higher while HDL-C was lower in the LVH group compared with the non-LVH group (MHR: 0.47 ± 0.11 vs. 0.33 ± 0.12, P &amp;lt; 0.001; HDL-C: 1.05 [0.94–1.22] vs. 1.27 [1.07–1.47] mmol/l, P &amp;lt; 0.001). Correlation analysis showed that LVMI was positively correlated with MHR (r = 0.381, P &amp;lt; 0.001). Multivariate logistic regression analysis showed that MHR was an independent risk factor for LVH in young and middle-aged EH patients (odds ratio = 2.914, 95% confidence interval [CI] 2.084–4.068, P &amp;lt; 0.001) after adjusting for body mass index, smoking, HDL-C, and other confounding factors. The area under the ROC curve of MHR for predict LVH was 0.831 (95% CI 0.782–0.880), and the optimal cutoff value of MHR was 0.37, with a sensitivity of 93.9% and a specificity of 75.5%. Conclusions MHR is positively correlated with LVH in young and middle-aged patients with EH. MHR is an independent risk factor for LVH in this population, and can be used for LVH risk screening.

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.

Effects of blood pressure percentile, body mass index, and race on left ventricular mass in children.

To evaluate the association of systolic blood pressure percentile, race, and body mass index with left ventricular hypertrophy on electrocardiogram and echocardiogram to define populations at risk. This is a retrospective cross-sectional study design utilising a data analytics tool (Tableau) combining electrocardiogram and echocardiogram databases from 2003 to 2020. Customized queries identified patients aged 2-18 years who had an outpatient electrocardiogram and echocardiogram on the same date with available systolic blood pressure and body measurements. Cases with CHD, cardiomyopathy, or arrhythmia diagnoses were excluded. Echocardiograms with left ventricle mass (indexed to height2.7) were included. The main outcome was left ventricular hypertrophy on echocardiogram defined as Left ventricle mass index greater than the 95th percentile for age. In a cohort of 13,539 patients, 6.7% of studies had left ventricular hypertrophy on echocardiogram. Systolic blood pressure percentile >90% has a sensitivity of 35% and specificity of 82% for left ventricular hypertrophy on echocardiogram. Left ventricular hypertrophy on electrocardiogram was a poor predictor of left ventricular hypertrophy on echocardiogram (9% sensitivity and 92% specificity). African American race (OR 1.31, 95% CI = 1.10, 1.56, p = 0.002), systolic blood pressure percentile >95% (OR = 1.60, 95% CI = 1.34, 1.93, p < 0.001), and higher body mass index (OR = 7.22, 95% CI = 6.23, 8.36, p < 0.001) were independently associated with left ventricular hypertrophy on echocardiogram. African American race, obesity, and hypertension on outpatient blood pressure measurements are independent risk factors for left ventricular hypertrophy in children. Electrocardiogram has little utility in the screening for left ventricular hypertrophy.

Abstract 15047: Effects of Blood Pressure Percentile, Body Mass Index, and Race on Left Ventricular Mass in Children

Introduction: Childhood hypertension, obesity, and left ventricular hypertrophy (LVH) are risk factors for premature cardiovascular events in adulthood, particularly among minorities. In children, race and body mass index (BMI) have been shown to be independently associated with LVH, with conflicting data on the association of systolic blood pressure (SBP) level with risk of LVH and utility of ECG in assessing LVH. This study looks at the association of SBP percentile, race, and BMI with LVH on electrocardiogram (ECG) and echocardiogram (echo) to define populations at risk. Methods: This is a retrospective cross-sectional study design utilizing a data analytics tool (Tableau) combining ECG and echo databases from 2003-2020. Customized queries identified patients ages 2-18 years old who had an outpatient ECG and echo on the same date with available SBP and body measurements. Cases with congenital heart disease, cardiomyopathy, or arrhythmia diagnoses were excluded. Echos with left ventricle mass (indexed to height 2.7 ) were included. The main outcome was LVH on echo defined as LV mass index greater than the 95 th percentile for age. Results: In a cohort of 13,926 patients, 6.9% of studies had LVH on echo. SBP percentile &gt; 90% has a sensitivity of 36% and specificity of 82% for LVH on echo. LVH on ECG was a poor predictor of LVH on echo (9% sensitivity and 92% specificity). African American race (OR 1.31, 95% CI = 1.11, 1.55, p=.001), SBP percentile &gt; 95% (OR=1.64, 95% CI = 1.37, 1.95, p &lt;.001), and higher body mass index (OR= 7.43, 95% CI = 6.44, 8.55, p &lt;.001) were independently associated with LVH on echo. Figure 1 shows the prevalence of LVH by African American race, obesity, and SBP. Conclusions: African American race, obesity, and hypertension are independent risk factors for LVH in children. Outpatient ECG has low utility in screening for LVH.

A meta-analytic evaluation of the diagnostic accuracy of the electrocardiographic Peguero-Lo Presti criterion for left ventricular hypertrophy.

Although electrocardiography (ECG) is a cost-effective and convenient tool for routine screening of left ventricular hypertrophy (LVH), its performance has been shown to be poor. The Peguero-Lo Presti, a novel voltage criterion, was found to be potentially better than the most commonly used criteria. We conducted a systematic review and meta-analysis of its diagnostic accuracy compared to Cornell and Sokolow-Lyon voltage criteria. Bibliographic databases were searched to identify relevant articles. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (ROC) curves were performed for comparison. Ten studies reporting data from 5984 individuals were included in the meta-analysis. Peguero-Lo Presti had the highest pooled sensitivity (43.0%, 95% confidence interval [CI]: 30.2-56.9) followed by Cornell (26.1%; 95% CI: 16.9-37.9) and Sokolow Lyon (22.0%; 95% CI: 14.1-32.7). However, Peguero-Lo Presti had the lesser pooled specificity (90.5%; 95% CI: 86.3-93.5) and Cornell the highest (94.9%; 95% CI: 90.3-97.3). The pooled DOR was 6.63 (95% CI: 3.95-11.13), 5.50 (95% CI: 3.64-8.30), and 2.94 (95% CI: 2.20-3.92) for Peguero-Lo Presti, Cornell, and Sokolow-Lyon, respectively. Peguero-Lo Presti had the best accuracy according to summary ROC curves, with an area under the curve of 0.827 compared to 0.715 for Cornell, and 0.623 for Sokolow-Lyon. In conclusion, according to this meta-analysis, Peguero-Lo Presti has a better diagnostic performance than Cornell and Sokolow-Lyon and might be more useful in routine clinical practice as a screening tool for LVH.

Abstract P345: Left Ventricular Hypertrophy Screening via Machine Learning for Young Adults

Background: A use of conventional 12-lead electrocardiographic (ECG) criteria and machine learning for the ECG parameters to identify the presence of left ventricular hypertrophy (LVH) is estimated 20%-30% in the general population. We developed an ECG system with simple anthropometric data using machine learning to increase the sensitivity in screening for LVH. Methods: In a large sample of 2,196 males, aged 17-45 years, the support vector machine (SVM) classifier with linear kernel 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 adult males as 116 g/m 2 (left ventricular mass (LVM)/body surface area) or 49 g/m 2.7 (LVM/body height 2.7 ). The samples are divided into a training/validation set and a test set. By applying the synthetic minority over-sampling technique (SMOTE) in pre-processing of training data, the imbalance in sample size between the Non-LVH and LVH cases can be solved. Results: For the test set with 440 cases, average accuracy, specificity, sensitivity, precision and F 1 score are 76.1%, 75.1%, 92.6%, 19.5% and 32.3%, respectively. The AUCs of ROC and PR curves are 0.871 and 0.272, respectively. To compare with the Cornell and Sokolow-Lyon voltage criteria as shown in Fig.1, all data of the 2,196 young males are also tested in the model. With the specificity of 73.3%, our SVM technique provides much better sensitivity 86.7% compared to 3.3% and 52.7% for the Cornell and Sokolow-Lyon voltage criteria, respectively. The body height and body weight are the most important factors among the 31 features in our SVM model. Conclusions: We provide a novel screening tool using simple anthropometrics and several ECG data to identify LVH in young adults and improves much in sensitivity as compared with the conventional ECG criteria or using machine learning for ECG data alone to identify LVH.

Limitations of Electrocardiography for Detecting Left Ventricular Hypertrophy or Concentric Remodeling in Athletes

BackgroundElectrocardiography (ECG) is used to screen for left ventricular hypertrophy (LVH), but common ECG-LVH criteria have been found less effective in athletes. The purpose of this study was to comprehensively evaluate the value of ECG for identifying athletes with LVH or a concentric cardiac phenotype. MethodsA retrospective analysis of 196 male Division I college athletes routinely screened with ECG and echocardiography within the Stanford Athletic Cardiovascular Screening Program was performed. Left-ventricular mass and volume were determined using echocardiography. LVH was defined as left ventricular mass (LVM) >102 g/m²; a concentric cardiac phenotype as LVM-to-volume (M/V) ≥1.05 g/mL. Twelve-lead electrocardiograms including high-resolution time intervals and QRS voltages were obtained. Thirty-seven previously published ECG-LVH criteria were applied, of which the majority have never been evaluated in athletes. C-statistics, including area under the receiver operating curve (AUC) and likelihood ratios were calculated. ResultsECG lead voltages were poorly associated with LVM (r = 0.18-0.30) and M/V (r = 0.15-0.25). The proportion of athletes with ECG-LVH was 0%-74% across criteria, with sensitivity and specificity ranging between 0% and 91% and 27% and 99.5%, respectively. The average AUC of the criteria in identifying the 11 athletes with LVH was 0.57 (95% confidence interval [CI] 0.56-0.59), and the average AUC for identifying the 8 athletes with a concentric phenotype was 0.59 (95% CI 0.56-0.62). ConclusionThe diagnostic capacity of all ECG-LVH criteria were inadequate and, therefore, not clinically useful in screening for LVH or a concentric phenotype in athletes. This is probably due to the weak association between LVM and ECG voltage.

Left ventricular hypertrophy identified by cardiac computed tomography and ECG in hypertensive individuals: a population-based study.

Screening of left ventricular hypertrophy (LVH) is a biomarker of organ damage in hypertensive individuals and associated with increased mortality. Cardiac computed tomography (CT) is widely expanding worldwide; however, the value of CT assessment of LVH is unknown. We aimed to identify individuals with LVH using both cardiac CT and electrocardiograms (ECG) and to explore potential differences between these phenotypical distinct diagnostic modalities. Participants in the Copenhagen General Population Study underwent 12-lead ECG and cardiac CT and were evaluated for the presence of LVH. Multiple ECG signs of LVH were compared with LVH by CT. Out of 4942 participants, 1347 had untreated hypertension and in this group, 13% presented with anatomical LVH by CT and 10% by ECG with an overlap of 4%. ECG signs of LVH had negative predictive values between 87 and 89% compared with CT. Using a combination of the Sokolow-Lyon index, the Cornell voltage duration product and/or a Romhilt-Estes score at least 4, lead to an increased C-statistics (P < 0.001) compared with the use of any single ECG sign of LVH. Individuals with solely CT but not ECG signs of LVH had higher SBPs (152 vs. 144 mmHg, P < 0.001) and larger left atria (49 vs. 45 ml/m, P < 0.001) compared with individuals with solely ECG LVH. CT and ECG identifies LVH in 19% of hypertensive individuals with only a small diagnostic overlap. Commonly used ECG criteria for LVH cannot safely rule out the presence of anatomical LV organ damage.

Serum MicroRNA-27b as a Screening Biomarker for Left Ventricular Hypertrophy.

MicroRNA-27b (miR-27b) is frequently upregulated in pressure-overloaded hypertrophic hearts. The clinical implications of aberrant circulating miR-27b in the diagnosis and management of left ventricular hypertrophy warrant study. We investigated whether serum miR-27b is a biomarker for left ventricular hypertrophy (LVH). We used stem-loop reverse-transcription quantitative polymerase chain reaction techniques to analyze serum miR-27b levels in 200 hypertensive patients with LVH, 100 hypertensive patients without LVH, and 100 healthy volunteers. We found that serum miR-27b levels were significantly higher in the hypertensive patients with LVH than in the hypertensive patients without LVH and in the healthy volunteers. Upon receiver operating characteristic curve analysis, serum miR-27b had an area under the curve of 0.885 with 91% sensitivity and 73% specificity in distinguishing hypertensive patients with LVH from healthy volunteers (P=0.021), and an area under the curve of 0.818 with 79.1% sensitivity and 70.3% specificity in distinguishing hypertensive patients with LVH from those without LVH (P=0.036). We conclude that circulating miR-27b might serve as a specific, noninvasive biomarker in screening for LVH.

L’hypertrophie ventriculaire gauche chez le sujet noir Africain hypertendu : résultats d’une enquête transversale, réalisée en milieu semi-rural au Sénégal

ObjectivesTo assess the prevalence of left ventricular hypertrophy according to electrocardiographic and echocardiographic criteria among hypertensive patients living in semi-rural Senegalese area. Patients and methodsAccording to the World Health Organization STEPSwise approach, we conducted, in November 2012, a cross-sectional and exhaustive study in the population aged at least 35 years old and living for at least six months in the semi-rural area of Guéoul. We researched electrocardiographic and echocardiographic left ventricular hypertrophy in hypertensive subjects. Data were analyzed with SPSS 18.0 software version. The significance level was agreed for a value of P<0.05. ResultsWe examined 1411 subjects aged on average of 48.5±12.7 years. In total, 654 subjects were hypertensive and screening of left ventricular hypertrophy (LVH) was effective in 515 of them. According to Sokolow-Lyon index, 86 subjects (16.7%) presented electrocardiographic LVH, more frequently in men (P=0.002). According to Cornell index and Cornell product, LVH was founded respectively in 66 (12.8%) and 52 subjects (10.1%), more frequently in female (P=0.0001; P=0.004). It was more common in grade 3 of hypertension however criteria. In echocardiography, prevalence of LVH was 2.2% (13 cases) according to the left ventricular mass, 9.3% (48 cases) according to the left ventricular mass indexed to body surface area and 8.2% (42 cases) according to the left ventricular mass indexed to height2.7. LVH was significantly correlated with the electrocardiographic LVH according to Sokolow-Lyon index (P<0.0001) and the grade 3 of hypertension (P=0.003). ConclusionAlthough rare in hypertensive Senegalese living in semi-rural area, left ventricular hypertrophy is correlated with severity of grade of hypertension. Screening by electrocardiogram will allow better follow-up of these hypertensive subjects.

OS 20-08 GENDER-ADJUSTMENT AND CUTOFF LEVELS OF CORNELL PRODUCT IN ELECTROCARDIOGRAM AMONG JAPANESE HYPERTENSIVE PATIENTS

Left ventricular hypertrophy (LVH) diagnosed by Cornell product in electrocardiogram predicted future stroke events at lower thresholds in Japanese general populations than those in western countries; therefore, we thought to evaluate whether the gender-adjustment and the levels of Cornell product to detect echo LVH was appropriate in Japanese subjects. We consecutively enrolled 345 hypertensive patients who were performed echocardiography for the screening of LVH. We evaluated Cornell voltage (S in leads V3 + R in leads aVL), Cornell product [(Cornell voltage, added 0.6 mV if females) × QRS duration] and left ventricular mass index (LVMI) (echo LVH; LVMI 116 > g/m2 in males and LVMI 96 > g/m2 in females. The mean age was 63.8 ± 12.5 years (males/females 174/172). There were 39 patients with echo LVH in males (22.7 %) and 64 patients in females (37.2 %). In linear regression model, the equations to estimate LVMI from Cornell voltage were as follows: (1) LVMI = 14.5 × Cornell voltage + 78.9 in males and (2) 21.5 × Cornell voltage + 61.5 in females. The cutoff levels to estimate echo LVH were 2.6 mV in males and 1.6 mV in females; the levels were lower than levels in the current guideline. In both gender, the area under curve (AUC) to detect echo LVH was increased from the gender-adjusted Cornell product (AUC = 0.690) to the gender-unadjusted Cornell product (AUC = 0.738). The equations to estimate LVMI from the gender-adjusted Cornell product were as follows: (1) LVMI = 0.15 × Cornell product + 68.8. In the receiver operating curve, the levels of Cornell product to estimated echo LVH were 170 mV × msec (sensitivity 0.74, specificity 0.60); these levels were also lower than the levels in the current guideline. The gender adjustment of Cornell product seems to be appropriate even in Japanese patients, but the levels detecting echo LVH may be lower than the levels in western countries.

Addition of N-terminal pro-B-type natriuretic peptide levels to electrocardiography criteria for detection of left ventricular hypertrophy: the ARIRANG study.

The utility of electrocardiography (ECG) in screening for left ventricular hypertrophy (LVH) in general populations is limited mainly because its low sensitivity. B-type natriuretic peptide (BNP) is released due to the remodeling processes of LVH and could improve the diagnostic accuracy for the ECG criteria for LVH. We hypothesized that addition of BNP levels to ECG criteria could aid LVH detection compared with ECG alone in a general population. We enrolled consecutive 343 subjects from a community-based cohort. LVH was defined as LV mass index > 95 g/m(2) for females and > 115 g/m(2) for males according to echocardiography. The area under the receiver operator characteristic (ROC) curve to detect LVH was 0.55 (95% confidence interval [CI], 0.50-0.61) in Sokolow-Lyon criteria and 0.53 (0.47-0.59) in the Cornell voltage criteria. After addition of N-terminal-proBNP levels to the model, the corresponding areas under the ROC were 0.63 (0.58-0.69) and 0.64 (0.59-0.69), respectively. P values for the comparison in areas under the ROC for models with and without N-terminal-proBNP levels were < 0.001. These data suggest that addition of N-terminal-proBNP levels to ECG criteria could significantly improve the diagnostic accuracy of LVH in general populations.

Reliability of electrocardiographic surrogates of left ventricular mass in patients with chronic kidney disease

Left ventricular hypertrophy (LVH) is a prevalent condition in chronic kidney disease (CKD) very often underdiagnosed and misdiagnosed. Electrocardiography (ECG) is an easily accessible LVH diagnostic tool. We evaluated the usefulness of commonly applied ECG criteria for LVH diagnosis in CKD patients. Cross-sectional evaluation of 253 nondialysis-dependent CKD stages 3-5 patients (61 [53-67] years; 65% men). Left ventricular mass (LVM) was assessed by echocardiography (ECHO). ECG was performed to assess Cornell voltage and Sokolow-Lyon voltage and their products (Cornell product and Sokolow-Lyon product, respectively). The prevalence of LVH ranged from 72 to 89% depending on ECHO criteria used. Cornell product showed the best correlation with ECHO-estimated LVM (ρ = 0.41; P <0.001). Across sex-specific tertiles of ECHO-LVM, ECG criteria increased and patients were more often hypertensive, obese, fluid overloaded, inflamed, and with higher albuminuria. Cornell product showed the strongest association with ECHO-LVM in crude and adjusted regression models, and the higher predictive performance for all the ECHO-based LVH definitions. However, when applying literature-based ECG cut-offs for LVH diagnosis, Sokolow-Lyon product showed a higher specificity. The agreement between ECG criteria cut-offs and ECHO-based definitions of LVH was in general poor, and the number of patients reclassified correctly by ECHO ranged from 77 to 94%. Our data suggest that ECG alone is a weak indicator of LVH, and do not support its routine use as a unique tool in the screening of LVH in CKD patients. Further studies are needed to confirm these results and to try establishing adequate cut-offs for LVH diagnosis in this population.

Detection of left ventricular hypertrophy in obesity

Detection of left ventricular hypertrophy in obesity

Addition of Highly Sensitive Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide to Electrocardiography for Detection of Left Ventricular Hypertrophy

Left ventricular hypertrophy (LVH) is an independent, modifiable risk factor for cardiovascular disease. However, current screening strategies are limited. In 2478 participants without clinical disease from the Dallas Heart Study, we evaluated a multimarker screening strategy that complements electrocardiographic (ECG) criteria for LVH with 2 biomarkers, amino-terminal pro-B-type natriuretic peptide and highly sensitive cardiac troponin T. An integer LVH risk score from 0 to 3 was determined as the sum of the following: (1) LVH by Sokolow-Lyon ECG; (2) amino-terminal pro-B-type natriuretic peptide in the highest sex-specific quartile; and (3) detectable cardiac troponin T. Cardiac magnetic resonance imaging–determined LVH served as the primary outcome. The probability of LVH increased from 2% with an LVH risk score of 0 to 50% with a score of 3 ( P &lt;0.001). Sokolow-Lyon ECG afforded low sensitivity (26% [95% confidence interval {CI}, 17–32%]) and high specificity (96% [95% CI, 95–97%]), whereas a risk score ≥2 offered higher sensitivity (44% [95% CI, 34–51%]) with good specificity (90% [95% CI, 89–93%]) and a score threshold of 1 offered reasonable sensitivity (76% [95% CI, 67–83%]) with lower specificity (55% [95% CI, 53–61%]) and high negative predictive value (98% [95% CI, 97–98%]). Area under the receiver operator characteristic curve improved from 0.760 (95% CI, 0.716–0.804) for ECG alone to 0.798 (95% CI, 0.754–0.842) for the LVH risk score ( P =0.0012), consistent with modest improvement in overall discrimination. Better screening for LVH may be achieved by combining simple tests, which collectively provide additional information compared with ECG alone. Further studies are needed to evaluate the impact and cost-effectiveness of a multimarker screening strategy.

Cardiac Biomarkers, Mortality, and Post-Traumatic Stress Disorder in Military Veterans

Post-traumatic stress disorder (PTSD) is gaining increasing recognition as a risk factor for morbidity and mortality. The aim of this study was to examine the impact of PTSD and abnormal cardiovascular biomarkers on mortality in military veterans. Eight hundred ninety-one patients presenting for routine echocardiography were enrolled. Baseline clinical data and serum samples for biomarker measurement were obtained and echocardiography was performed at the time of enrollment. Patients were followed for up to 7.5 years for the end point of all-cause mortality. Ninety-one patients had PTSD at the time of enrollment. There were 33 deaths in patients with PTSD and 221 deaths in those without PTSD. Patients with PTSD had a trend toward worse survival on Kaplan-Meier analysis (p = 0.057). Among patients with elevated B-type natriuretic peptide (>60 pg/ml), those with PTSD had significantly increased mortality (p = 0.024). Among patients with PTSD, midregional proadrenomedullin (MR-proADM), creatinine, and C-terminal proendothelin-1 were significant univariate predictors of mortality (p = 0.006, p = 0.024, and p = 0.003, respectively). In a multivariate model, PTSD, B-type natriuretic peptide, and MR-proADM were independent predictors of mortality. In patients with PTSD, MR-proADM was a significant independent predictor of mortality after adjusting for B-type natriuretic peptide, cardiovascular risk factors, cancer, and sleep apnea. Adding MR-proADM to clinical predictors of mortality increased the C-statistic from 0.572 to 0.697 (p = 0.007). In conclusion, this study demonstrates an association among PTSD, abnormal cardiac biomarker levels, and increased mortality.

Better criterion screening for left ventricular hypertrophy by electrocardiogram with different purposes

According to the recommendations for the standardization and interpretation of the electrocardiogram (ECG) of AHA/ACCF/HRS declared in 2009, there are more than 30 criteria for diagnosing left ventricular hypertrophy (LVH). The sensitivity of the various criteria is generally quite low. However, the specificity of ECG in LVH could be 85 to 90%, acting as a strong predictor for cardiovascular events. To investigate the proper criteria in epidemiological screening with different purpose, 5209 qualified ECG out of 6830 people were selected from cross-sectional Handan eye study. Two criteria were chosen: (1) Sokolow-Lyon index, sum of SV1+RV5 or V6 ≥ 35 mm; (2) Cornell voltage duration product, men: (SV3+RaVL)×QRS duration ≥2440 ms; women: (SV3+(RaVL+8 mV))×QRSduration ≥ 2440 ms. The ECG-LVH group contains 829 individuals (12.18% of the cohort), including 607 by Sokolow-Lyon index and 278 by Cornell voltage duration product. After data estimation, we found that there were no statistical differences between ECG-LVH population and normal population. While evaluated these data in the group that have retinopathy without diabetes, the Sokolow-Lyon index and Cornell voltage duration product were statistically different with normal population (P= 0.023 and P= 0.014, respectively). We use the simple MiniMental State Examination (MMSE) to evaluated the mental status of the population and found that when the score was above 15, there was no statistically different between the positive and negative people in Sokolow-Lyon index (P= 0.135); however, in evaluated Cornell voltage duration product, there was statistical difference (P=0.001). When we evaluated the data associated with atherosclerotic factors, we found no differences in Cornell voltage-duration product; as for the Sokolow-Lyon index, the differences were shown in systolic blood pressure, total cholesterols and uric acid (P= 0.03, 0.04 and 0.04, respectively). Different criterion should be chosen for different purposes. For atherosclerotic screening or epidemiological survey of cardiovascular diseases, the Sokolow-Lyon index might be better. If we use the criterion for epidemiological ophthalmology such as our Handan eye study, both Sokolow-Lyon index and Cornell voltage duration product could be used. As for the evaluation of mental status and its relationship with the LVH risk factors, we might choose Cornell voltage duration product. Key words: Left ventricular hypertrophy, electrocardiagram, Sokolow-L(l)yon index, Cornell voltage-duration product.