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

2022 ◽  
Author(s):  
Maren Maanja ◽  
Todd T Schlegel ◽  
Rebecca Kozor ◽  
Ljuba Bacharova ◽  
Timothy C Wong ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Healthy Volunteers ◽  
Ventricular Hypertrophy ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Prognostic Performance ◽  
Test Specificity ◽  
Qrs Duration ◽  
Ventricular Electrical Remodeling ◽  
Ecg Criteria

Background: Conventional electrocardiographic (ECG) signs of left ventricular hypertrophy lack sensitivity, The aim was to identify LVH based on an abnormal spatial peaks QRS-T angle, and evaluate its diagnostic and prognostic performance compared to that of conventional ECG criteria for LVH. Methods: This was an observational study with four cohorts, all with a QRS duration <120 ms: (1) Healthy volunteers to define normality (n=921), (2) Separate healthy volunteers to compare test specificity (n=461), (3) Patients with at least moderate LVH by cardiac imaging (Imaging-LVH) to compare test sensitivity (n=225), and (4) Patients referred for cardiovascular magnetic resonance imaging to evaluate the combined outcome of hospitalization for heart failure or all-cause death (Clinical-Consecutive, n=783). Results: An abnormal spatial peaks QRS-T angle was defined as exceeding the upper limit of normal, which was found to be ≥40° for females and ≥55° for males. In healthy volunteers, the specificity of the QRS-T angle to detect LVH was 96% (females) and 98% (males). In Imaging-LVH, the QRS-T angle had a higher sensitivity to detect LVH than conventional ECG criteria (93-97% vs 13-56%, p<0.001 for all). In Clinical-Consecutive, of those who did not have any LVH, 238/556 (43%) had an abnormal QRS-T angle, suggesting it can occur even without LVH. There was an association with outcomes in univariable analysis for the QRS-T angle, Cornell voltage, QRS duration, and Cornell product (hazard ratios 1.68-2.5, p<0.01 for all) that persisted in multivariable analysis only for the QRS-T angle and QRS duration (p<0.001 for both). Conclusions: An increased 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, associated with outcomes. Thus, an increased QRS-T angle identifies left ventricular electrical remodeling that can occur in the absence of LVH detected by imaging. The improved diagnostic and independent prognostic performance for the QRS-T angle suggests that it should be investigated when ECGs are evaluated.

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

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Haxha ◽  
U Pedersen-Bjergaard ◽  
J.B Nielsen ◽  
J Pallisgaard ◽  
R.B Devereux ◽  
...  
Keyword(s):  
Primary Care ◽  
Left Ventricular Hypertrophy ◽  
Predictive Value ◽  
Ventricular Hypertrophy ◽  
Strong Predictor ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Type I ◽  
All Cause Mortality ◽  
Cornell Voltage

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 &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&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&lt;0.001). CL identified a larger percentage of LVH in DM compared to non-DM individuals (8.0% vs. 5.6%, p&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&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

The Peguero-Lo Presti criteria has the highest diagnostic accuracy for the diagnosis of left ventricular hypertrophy in the elderly

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C.A.M Tavares ◽  
N Samesima ◽  
L.A Hajjar ◽  
L.C Godoy ◽  
E.M.P Hirano ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Diagnostic Accuracy ◽  
Ventricular Hypertrophy ◽  
The Elderly ◽  
Left Ventricular ◽  
Accuracy Score ◽  
Increased Sensitivity ◽  
Low Sensitivity ◽  
Ecg Criteria ◽  
Improved Accuracy

Abstract Background Left Ventricular Hypertrophy (LVH) is an independent predictor of mortality and cardiovascular morbidity and the 12-lead ECG is recommended as a universal screening for patients with hypertension. However, the ECG has low sensitivity and there is limited data in patients 70 years or older. The recently published Peguero-Lo Presti (PLP) criteria had improved accuracy compared with other ECG criteria but with very few patients with age ≥70 years included. Purpose To compare the accuracy of the PLP criteria versus the traditional ECG criteria for detecting LVH in patients ≥70 years. Methods Retrospective single-center study. Patients were included if they were 70 years or older and underwent an ECG and echocardiogram (gold standard) less than 180 days apart from jan/2017 to mar/2018. Patients with left or right bundle branch block, non-sinus rhythm or ventricular paced rhythm were excluded. All tracings were independently reviewed by two cardiologists, blinded to the echocardiogram. The PLP criteria was compared against Cornell voltage (CV), Sokolow-Lyon voltage (SL), and Romhilt-Estes 4 and 5 (RE) criteria. LVH was defined as a left ventricular mass index &gt;115 g/m2 in males and &gt;95 g/m2 in females, according to the echocardiogram. McNemar's test, F1 score, and the area under the Receiver Operating Characteristic curves (AUC) were used to compare the diagnostic performance of the tests Results A total of 592 patients were included (mean age 77.5 years, SD: 5.9; 50.8% were women). The PLP criteria had increased sensitivity compared with both the SL and CV criteria (p&lt;0.0001 for both comparisons) and RE5 (p=0.042). PLP also had better specificity than the RE4 criteria (p&lt;0.0001) and the highest F1 accuracy score (Table 1). The AUC of the PLP was significantly higher than the AUC of the CV and RE criteria (0.70 vs 0.66 vs 0.64, respectively, p&lt;0.05) and numerically higher than the SL criteria (AUC=0.67, p=0.311, Figure 1). Conclusion Compared to the traditional ECG criteria for LVH, the PLP criteria had the highest diagnostic accuracy in elderly patients. Figure 1. AUC of the ECG criteira Funding Acknowledgement Type of funding source: None

scholarly journals Prevalence and pattern of echocardiographic abnormalities among patients on haemodialysis at an urban hospital in Central Uganda

2020 ◽  
Vol 23 (1) ◽  
Author(s):  
Grace Kansiime ◽  
Robert Kalyesubula ◽  
Emmy Okello ◽  
Ponsiano Ocama
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Diastolic Dysfunction ◽  
Ventricular Hypertrophy ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Sub Saharan Africa ◽  
Chronic Haemodialysis ◽  
Urban Hospital ◽  
Cardiac Abnormalities ◽  
High Prevalence

Background: Cardiovascular disease is the most common cause of morbidity and premature mortality in patients on chronic haemodialysis. There are limited data on cardiac abnormalities among these patients in sub-Saharan Africa, including Uganda. We determined the prevalence and patterns of echocardiographic (echo) abnormalities among patients with end-stage renal disease (ESRD) on haemodialysis at Mulago National Referral Hospital, Kampala, Uganda. Methods: Eighty patients with ESRD on chronic haemodialysis were enrolled in the study over a period of five months from November 2017 to March 2018. We collected data on demographic and baseline clinical characteristics by reviewing charts and conducting patient interviews. Participants had blood pressure measurements performed and blood samples taken for laboratory investigations. We then conducted a cardiac evaluation using standard transthoracic echo protocols. Bivariable and multivariable analysis was performed to study associations with left ventricular hypertrophy and diastolic dysfunction. Results: Fifty-three of the 80 patients (66%) were male, mean age was 49 ± 16 years and the median duration on dialysis was 9.5 months (interquartile range 4–24 months). Twenty-eight (35%) had to travel >50 km to access dialysis. Seventy-four patients (93%) had at least one cardiac echo abnormality and 30% had at least three abnormalities. Left ventricular hypertrophy (68%) and diastolic dysfunction (64%) were the most common abnormalities. There was a high prevalence of factors that have previously been associated with left ventricular hypertrophy and diastolic dysfunction including anaemia (79%), poorly controlled hypertension (79%) and dyslipidaemia (56%) but none of these was statistically significantly associated in this study. Conclusions: Our study confirmed a high prevalence of cardiac abnormalities among a young population of African patients with ESRD on chronic dialysis. We recommend that echocardiography be part of the routine care to help plan early intervention for those at high risk of cardiovascular events.

scholarly journals Performance of Electrocardiographic Criteria for Echocardiographically Diagnosed Left Ventricular Hypertrophy in Chinese Hypertensive Patients

2020 ◽  
Vol 33 (9) ◽  
pp. 831-836 ◽  
Author(s):  
Dian Wang ◽  
Jian-Zhong Xu ◽  
Wei Zhang ◽  
Yi Chen ◽  
Jian Li ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
High Specificity ◽  
Left Ventricular ◽  
Hypertensive Patients ◽  
Receiver Operating Characteristic Curves ◽  
Low Sensitivity ◽  
Ecg Criteria ◽  
Cornell Voltage ◽  
Cornell Product

Abstract BACKGROUND Performance of electrocardiographic (ECG) criteria for echocardiographically diagnosed left ventricular hypertrophy (LVH) in Chinese hypertensive patients is not well known. We investigated the accuracy of various ECG criteria for the diagnosis of the echocardiographic LVH according to the new cutoff values of left ventricular mass (LVM) index (&gt;115 g/m2 for men and &gt;95 g/m2 for women) in Chinese hypertensive patients. METHODS Our study included 702 consecutive hypertensive inpatients including 92 (13.1%) concentric and 121 (17.2%) eccentric LVH on standard echocardiography. Diagnostic accuracy of 7 ECG criteria was evaluated by calculating sensitivity and specificity and by using the receiver operating characteristic curves. RESULTS The ECG criteria for the detection of the echocardiographically defined LVH had a sensitivity of 15%–31.9% and specificity of 91.6%–99.2% overall, 20.7%–43.5% and 91.6%–99.2% concentric, and 7.4%–23.1% and 91.6%–99.2% eccentric. ECG diagnosis of LVH defined as the positive diagnosis of any of 4 ECG criteria including Sokolow–Lyon voltage, Cornell voltage, Cornell product, and RavL voltage had a sensitivity of 54% and specificity of 86.3% overall, 71.7% and 86.3% concentric, and 40.5% and 86.3% eccentric. After adjustment for confounding factors, various ECG criteria were significantly correlated with LVM, with standardized β coefficients from 0.20 to 0.39 (P &lt; 0.001) and the highest coefficient for the Cornell product criterion. CONCLUSIONS All ECG LVH indexes had low sensitivity and high specificity in Chinese hypertensive patients. Combination of 4 or all ECG criteria might improve sensitivity without any loss of specificity.

scholarly journals New Gender-Specific Partition Values for ECG Criteria of Left Ventricular Hypertrophy

Hypertension ◽  
2004 ◽  
Vol 44 (2) ◽  
pp. 175-179 ◽  
Author(s):  
Khaled Alfakih ◽  
Kevin Walters ◽  
Tim Jones ◽  
John Ridgway ◽  
Alistair S. Hall ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Ecg Criteria ◽  
Gender Specific

scholarly journals Automatic Electrocardiogram Detection of Suspected Hypertrophic Cardiomyopathy: Application to Wearable Heart Monitors

2021 ◽  
Author(s):  
Max Denis ◽  
Mulatu Bachoro ◽  
Winta Gebreslassie ◽  
Timothy Oladunni
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Left Ventricular Hypertrophy ◽  
Healthy Volunteers ◽  
Ventricular Hypertrophy ◽  
Detection Algorithm ◽  
Left Ventricular ◽  
P Value ◽  
S Wave ◽  
Healthy Human ◽  
Total N

In this work, an automatic detection algorithm for hypertrophic cardiomyopathy (HCM) is presented. Of particular interest is the ability of the algorithm to differentiate HCM subjects and healthy volunteers from a single lead ECG dataset. Suspected HCM subjects are identified by the primary clinical abnormality associated with HCM, left ventricular hypertrophy (LVH). In total, n=43 human subjects ECG datasets are investigated: n=21 healthy volunteers and n=22 left ventricular hypertrophy (LVH) patients. Significant differences of p-value 0.01 and 0.04 were found for the respective ECG parameters, S-wave amplitude and ST-segment, when differentiating between the LVH patients and healthy human volunteers.

scholarly journals Comparison of Various ECG Criteria in the Diagnosis of Left Ventricular Hypertrophy Using Echocardiography as Gold Standard

2020 ◽  
Vol 7 (8) ◽  
pp. 377-380
Author(s):  
Gailin B. Sebastian ◽  
Ish Kalra ◽  
Zameel A ◽  
Farha Ahmed Payyanil Karlath ◽  
Vivek S. Narayan Pillai
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Gold Standard ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Ecg Criteria
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