Assessment of left ventricular hypertrophy in patients with essential hypertension. A rational basis for the electrocardiogram

Department of Internal Medicine, School of Cardiovascular Diseases, II University of Rome, Italy.
American Journal of Hypertension (Impact Factor: 2.85). 02/1993; 6(2):164-9.
Source: PubMed


There is a large body of evidence that the electrocardiogram (ECG) is insensitive in the recognition of left ventricular hypertrophy (LVH), in comparison with the echocardiogram; however, its specificity is high. In this study we further analyzed the performance of the ECG in detecting LVH in 200 consecutive patients (124 men and 76 women, mean age 50.9 years) with mild to moderate essential hypertension, using echocardiographically determined left ventricular mass (LVM) as the standard for comparison. To test the hypothesis that, owing to the high number of true positive findings, the ECG may still be useful for clinical purposes by selecting subsets of hypertensives with higher degrees of LVH, we compared the mean values of LVM index corresponding to either positive (true positive) or negative (false negative) electrocardiographic signs of LVH. In this study 69 patients (34.5%) had echocardiographic LVH, as defined by a LVM index exceeding 125 g/m2 for men and 112 g/m2 for women. Almost all criteria demonstrated high levels of specificity (> or = 89%). In the whole group the Lewis index ((RI - RIII)+(SIII - SI) > or = 17 mm) showed a slight superiority in diagnosing LVH (sensitivity = 43%) in comparison to the remaining criteria; the confidence intervals estimate of sensitivities confirmed such diagnostic superiority only with respect to those criteria with a sensitivity < or = 17%. However, the use of McNemar's test to compare sensitivities of all electrocardiographic criteria at matched specificities (> or = 95%) did not show significant differences (P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)

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    ABSTRACT: Introduction: It has been suggested that hypertension (HTN) is associated with certain target organ damage (TOD) and related clinical conditions. On the other hand, left ventricular hypertrophy (LVH) has been considered as an independent risk factor of cardiovascular events and death. The aim of this study was to examine the relationship between HTN-induced LVH and TOD (retinopathy and renal failure). Methods: We assessed 102 hypertensive subjects (43 males and 59 females) with a mean age of 60.2 +/− 8.8 (range 35-81) years. LVH was defined as a left ventricular mass index (LVMI) of more than 51 and 47 g/(m (to the power of 2.7)), in men and women, respectively. The degree of retinopathy on ophthalmological examination was defined according to the Keith-Wagener classification. Serum creatinine, blood urea nitrogen and urine protein concentrations were also measured. Results: Hypertensive retinopathy was found in 94 (92.2 percent) cases (Grades I 55.9 percent; II 28.5 percent; III 3.9 percent; IV: 3.9 percent). The mean systolic and diastolic blood pressures and serum creatinine concentration showed significant correlation with the severity of LVH. There was no significant relationship between LVH severity and retinopathy or proteinuria. Conclusion: The tight control of systolic and diastolic blood pressures in the first step of essential hypertension can assist to postpone LVH. Furthermore, routine measurement of serum creatinine can predict the risk of cardiovascular complications in the hypertensive patient.
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    ABSTRACT: Easily applicable, clinically relevant electrocardiographic criteria are needed to screen large populations for left ventricular (LV) hypertrophy. The aim of this study was to evaluate, in a population of 380 hypertensive patients of both sexes, whether obesity modified the diagnostic performance of Sokolow-Lyon and Cornell voltage criteria by comparing them with echocardiographic evaluations using different indexation methods for LV mass presentation (body surface area and various powers of the height variable). For the population as a whole, Cornell voltage was better correlated to LV mass than was Sokolow-Lyon voltage (r = 0.48 and 0.36, respectively). The poorest performance of Sokolow-Lyon voltage was observed among obese patients (best r = 0.1 and 0.21 in obese women and men, respectively). Sensitivities were assessed at a 95% specificity level. In nonobese patients, using sex-adjusted voltage values (43 and 36 mm in men and women, respectively, for Sokolow-Lyon voltage, and 28 and 25 mm for Cornell voltage), the sensitivities of Cornell voltage and Sokolow-Lyon voltage were similar in men and women (near 22% and 36%, respectively), whatever the indexation method used for LV mass. In obese patients, Cornell voltage sensitivity was similar to that of nonobese patients, whereas Sokolow-Lyon voltage had a much poorer sensitivity (<10%). For simple LV hypertrophy detection criteria, Sokolow-Lyon voltage should be avoided in obese hypertensive patients and replaced by the Cornell voltage criteria, which are not influenced by the presence of obesity.
    The American Journal of Cardiology 04/1996; 77(9):739-44. DOI:10.1016/S0002-9149(97)89209-0 · 3.28 Impact Factor
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