Assessment of left ventricular hypertrophy in patients with essential hypertension. A rational basis for the electrocardiogram.
ABSTRACT 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: Cardiac computed tomography (CT) is a state-of-the-art technology that provides an accurate noninvasive method to quantify left ventricular mass for analysis of left ventricular hypertrophy (LVH). We aimed to examine seven ECG-based LVH criteria against two CT indexation criteria for LVH: a CT-specific body surface area cutoff and the obesity-independent height criteria. In 333 patients (mean age 53 +/- 12 years, 61% men), 64-slice contrast-enhanced CT was performed and 12-lead surface ECG within 24 h. Left ventricular mass was measured at end-diastole. Using both CT indexation criteria, the cohort was subdivided into patients with LVH and without LVH. The seven ECG criteria for LVH were the Cornell voltage index, Cornell voltage duration product, Cornell/strain index, Sokolow-Lyon index, Romhilt-Estes scores at least 4 and at least 5, and Gubner-Ungerleider. The ECG parameters had high specificities (85-97%) and variable low sensitivities (4-43%) when compared to either CT criteria of LVH. The three Cornell-based methods performed the best (test-positive likelihood ratio: 4.5-6.7), followed by the Sokolow-Lyon and Romhilt-Estes scores (test-positive likelihood ratio: 2.3-4.0). With the exception of the Gubner-Ungerleider criterion, the other six ECG criteria were associated with at least one of the CT-based LVH (adjusted odds ratio 2.4-9.5) and had incremental predictive value beyond that of hypertension history. Using cardiac CT as a gold standard for LVH assessment, ECG criteria for LVH have high specificities with the three Cornell-based criteria providing the best test performance for identifying patients with LVH.Journal of Hypertension 05/2010; 28(9):1959-67. · 4.22 Impact Factor
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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.
Article: HypertensionArchives of Cardiovascular Diseases. 04/2008; 101(4):250–254.