scholarly journals Discrepancy between left ventricular hypertrophy by echocardiography and electrocardiographic hypertrophy: clinical characteristics and outcomes

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001765
Author(s):  
Yuta Seko ◽  
Takao Kato ◽  
Yuhei Yamaji ◽  
Yoshisumi Haruna ◽  
Eisaku Nakane ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Significant Risk ◽  
Left Ventricular ◽  
Major Adverse Cardiovascular Events ◽  
Clinical Events ◽  
Pacemaker Placement ◽  
Study Population ◽  
Qrs Duration ◽  
Cornell Product

BackgroundThe clinical significance of the discrepancy between left ventricular hypertrophy (LVH) by echocardiography and ECG remains to be elucidated.MethodsAfter excluding patients who presented with pacemaker placement, QRS duration ≥120 ms and cardiomyopathy and moderate to severe valvular disease, we retrospectively analysed 3212 patients who had undergone both scheduled transthoracic echocardiography (echo) and ECG in a hospital-based population. Cornell product >2440 mm · ms was defined as ECG-based LVH; left ventricular mass index >115 g/m2 for men and >95 g/m2 for women was defined as echo-based LVH. The study population was categorised into four groups: patients with both ECG-based and echo-based LVH (N=131, 4.1%), those with only echo-based LVH (N=156, 4.9%), those with only ECG-based LVH (N=409, 12.7%) and those with no LVH (N=2516, 78.3%).ResultsThe cumulative 3-year incidences of a composite of all-cause death and major adverse cardiovascular events were 32.0%, 33.8%, 19.2% and 15.7%, respectively. After adjusting for confounders, the HRs relative to that in no LVH were 1.63 (95% CI 1.16 to 2.28), 1.68 (95% CI 1.23 to 2.30) and 1.09 (95% CI 0.85 to 1.41) in patients with both ECG-based and echo-based LVH, those with only echo-based LVH, and those with only ECG-based LVH, respectively.ConclusionsEcho-based LVH without ECG-based LVH was associated with a significant risk of adverse clinical events, and the risk was comparable to that in patients with both echo-based and ECG-based LVH.

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 (>115 g/m2 for men and >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 < 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 Cornell Product Left Ventricular Hypertrophy in Electrocardiogram and the Risk of Stroke in a General Population

Hypertension ◽  
2009 ◽  
Vol 53 (1) ◽  
pp. 28-34 ◽  
Author(s):  
Joji Ishikawa ◽  
Shizukiyo Ishikawa ◽  
Tomoyuki Kabutoya ◽  
Tadao Gotoh ◽  
Kazunori Kayaba ◽  
...  
Keyword(s):  
General Population ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Cornell Product

scholarly journals Study of Cardiac Autonomic Neuropathy and Left Ventricular Hypertrophy in type-II diabetic patients

2021 ◽  
Vol 12 (3) ◽  
pp. 2200-2206
Author(s):  
Kranthi Kumar Garikapati ◽  
Yogesh Tripath ◽  
Rinku Garg ◽  
Bindu Garg
Keyword(s):  
Heart Rate ◽  
Left Ventricular Hypertrophy ◽  
Autonomic Neuropathy ◽  
Time Domain ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Cardiac Autonomic Neuropathy ◽  
Healthy Controls ◽  
Cornell Voltage ◽  
Cornell Product

Cardiac autonomic neuropathy (CAN) is a frequent and intractable complication of diabetes. Reduction in heart rate variability (HRV) is the first sign of CAN in its subclinical stage. Autonomic imbalance and hyperglycaemia in diabetes are associated with cardiovascular structural and functional modifications, which lead to left ventricular hypertrophy (LVH). The study was undertaken to assess the changes in HRV and left ventricular mass in type 2 diabetes mellitus (T2DM) patients. The case-control study was conducted on 78 T2DM subjects and 78 age & sex-matched healthy controls. CAN be assessed by frequency and time-domain parameters of HRV and LVH was measured using various ECG criteria including Cornell voltage, Cornell product, Sokolow-Lyon voltage, and Romhilt-Estes point score. All the frequency and time-domain parameters of HRV except resting heart rate, normalized LF, and LF/HF ratio were significantly reduced in T2DM patients compared to healthy controls. The prevalence of ECG-LVH was 25.7% using any single criteria and 12.2% with all the criteria. The highest prevalence (24.3%) was noted with Cornell product and Sokolow-Lyon voltage criteria, followed by Romhilt-Estes point score (17.6%) and Cornell voltage criteria (16.2%). Reduction in overall HRV with less high-frequency power and high LF/HF ratio suggests parasympathetic dysfunction and sympathetic predominance. A significant LVH was noted with ECG-based electric criteria in T2DM patients. The study suggests that T2DM patients should be subjected to diagnostic HRV and ECG to identify the early occurrence of CAN and LVH.

Abstract 1936: Cornell Product Left Ventricular Hypertrophy In Electrocardiogram Is A Strong Predictor Of Stroke In Community-dwelling Japanese Normotensives

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Joji Ishikawa ◽  
Shizukiyo Ishikawa ◽  
Kazunori Kayaba ◽  
Kazuyuki Shimada ◽  
Kazuomi Kario
Keyword(s):  
General Population ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Cox Regression ◽  
Left Ventricular ◽  
Community Dwelling ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
Japanese General Population ◽  
Cornell Product

Background : Incidence of stroke is higher than ischemic heart disease in Japanese. Left ventricular hypertrophy (LVH) is associated with an increased risk for stroke among hypertensives. We evaluated the risk of LVH among normotensives (SBP/DBP<120/80 mmHg) subjects. Methods: In a Japanese general population, 10755 subjects who were undertaken electrocardiogram and measured BP at baseline were evaluated Cornell product (CP) and Sokolow-Lyon (SL) voltage as markers of LVH (CP≥2440 mm ms and SL voltage>35 mm). Follow-up was performed for 10 years and incidence of stroke was evaluated. Results: Prevalence of CP-LVH were 2.7% for normotensives, 5.2 % for prehypertensives, 11.0 % for hypertensives, and that of SL-LVH were 8.6%, 11.4%, and 22.5%, respectively. In overall subjects, CP-LVH and SL-LVH were independent predictors of stroke [CP-LVH: hazard risk (HR) 1.65, 95% confidence interval (CI) 1.22–2.25, SL-LVH: HR 1.30, 95%CI 1.02–1.65] after adjustment for confounding factors. In Cox regression analysis in each stage of hypertension, hazard ratios of stroke in subjects with CP-LVH were higher among normotensives (HR 8.28, 95%CI 3.72–18.41) than among prehypertensives (HR 1.56, 95%CI 0.67–3.63) and hypertensives (HR 1.48, 95%CI 1.02–2.13) (Figure ), although that in subjects with SL-LVH were not significant (normotensives: HR 1.54, 95%CI 0.70–3.40, prehypertensives: HR 1.29, 95%CI 0.72–2.32, hypertensives: HR 1.21, 95%CI 0.90–1.62). Conclusion: The ECG-LVH independently predicted future stroke in a Japanese general population. The specificity of the Cornell product-LVH is higher than that of Sokolow-Lyon-LVH especially among normotensive subjects <120/80 mmHg.

Abstract 2180: Relationship of Left Ventricular Systolic Function to Persistence or Development of Electrocardiographic Left Ventricular Hypertrophy in Hypertensive Patients: Implications for the Development of New Heart Failure

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Peter M Okin ◽  
Kristian Wachtell ◽  
Eva Gerdts ◽  
Kurt Boman ◽  
Markku S Nieminen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Diastolic Pressure ◽  
Systolic Function ◽  
Left Ventricular ◽  
Lv Function ◽  
Increased Risk ◽  
Cornell Product

Background : We have previously demonstrated that persistence or development of ECG left ventricular hypertrophy (LVH) by Cornell product criteria are associated with an increased risk of developing heart failure (HF) compared with regression or continued absence of LVH. We postulated that this relationship might be in part mediated via worse LV systolic function in patients with new and persistent LVH. Methods : Baseline and year-3 ECG LVH and LV midwall shortening (MWS) were examined in 725 patients in the LIFE echocardiographic substudy. MWS was measured and considered abnormal if <14.2%; stress-corrected MWS (scMWS) was considered abnormal if 2440 mm-msec. Results : Between baseline and 3 years follow-up, there was continued absence (n=260) or regression (n=167) of LVH in 427 patients and persistence (n=259) or development (n=39) of ECG LVH in 298 patients. Although there was no difference in baseline prevalence of abnormal MWS (23.4 vs 26.5%, p=0.389) or abnormal scMWS (24.6 vs 26.4%, p=0.663) between groups, after 3 years follow-up persistence or development of new LVH was associated with significantly lower mean MWS and scMWS and with higher prevalence and odds of abnormal MWS and scMWS than continued absence or regression of LVH (Table ). After controlling for differences in age, gender, race, treatment group, baseline and change from baseline to year-3 of heart rate, Sokolow-Lyon voltage, systolic and diastolic pressure and baseline severity of LVH by Cornell product, persistent or new ECG LVH remained associated with a >2-fold increased risk of abnormal MWS or scMWS at year 3. Conclusions : Persistence or development of new ECG LVH during antihypertensive therapy is associated with an increased risk of LV systolic dysfunction after 3 years of follow-up. These findings provide insight into a possible mechanism by which changes in ECG LVH are associated with changing risk of developing HF. < Midwall LV Function in Relation to Persistence or Development of ECG LVH Between Baseline and Year-3

Standard ECG for differential diagnosis between Anderson-Fabry disease and hypertrophic cardiomyopathy

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318271
Author(s):  
Giovanni Vitale ◽  
Raffaello Ditaranto ◽  
Francesca Graziani ◽  
Ilaria Tanini ◽  
Antonia Camporeale ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Hypertrophic Cardiomyopathy ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
St Depression ◽  
C Statistic ◽  
Pr Interval ◽  
Qrs Duration ◽  
Ecg Score

ObjectivesTo evaluate the role of the ECG in the differential diagnosis between Anderson-Fabry disease (AFD) and hypertrophic cardiomyopathy (HCM).MethodsIn this multicentre retrospective study, 111 AFD patients with left ventricular hypertrophy were compared with 111 patients with HCM, matched for sex, age and maximal wall thickness by propensity score. Independent ECG predictors of AFD were identified by multivariate analysis, and a multiparametric ECG score-based algorithm for differential diagnosis was developed.ResultsShort PR interval, prolonged QRS duration, right bundle branch block (RBBB), R in augmented vector left (aVL) ≥1.1 mV and inferior ST depression independently predicted AFD diagnosis. A point-by-point ECG score was then derived with the following diagnostic performances: c-statistic 0.80 (95% CI 0.74 to 0.86) for discrimination, the Hosmel-Lemeshow χ2 6.14 (p=0.189) for calibration, sensitivity 69%, specificity 84%, positive predictive value 82% and negative predictive value 72%. After bootstrap resampling, the mean optimism was 0.025, and the internal validated c-statistic for the score was 0.78.ConclusionsStandard ECG can help to differentiate AFD from HCM while investigating unexplained left ventricular hypertrophy. Short PR interval, prolonged QRS duration, RBBB, R in aVL ≥1.1 mV and inferior ST depression independently predicted AFD. Their systematic evaluation and the integration in a multiparametric ECG score can support AFD diagnosis.

scholarly journals ECG is an inefficient screening-tool for left ventricular hypertrophy in normotensive African children population

PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e2439 ◽  
Author(s):  
Giuseppe Di Gioia ◽  
Antonio Creta ◽  
Cosimo Marco Campanale ◽  
Mario Fittipaldi ◽  
Riccardo Giorgino ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Standard Technique ◽  
Left Ventricular ◽  
Poor Correlation ◽  
Pediatric Hypertension ◽  
Left Ventricle Mass ◽  
African Children ◽  
Study Population ◽  
The Relationship

BackgroundLeft ventricular hypertrophy (LVH) is a marker of pediatric hypertension and predicts development of cardiovascular events. Electrocardiography (ECG) screening is used in pediatrics to detect LVH thanks to major accessibility, reproducibility and easy to use compared to transthoracic echocardiography (TTE), that remains the standard technique. Several diseases were previously investigated, but no data exists regarding our study population. The aim of our study was to evaluate the relationship between electrocardiographic and echocardiographic criteria of LVH in normotensive African children.MethodsWe studied 313 children (mean age 7,8 ± 3 yo), in north-Madagascar. They underwent ECG and TTE. Sokolow-Lyon index was calculated to identify ECG-LVH (>35 mm). Left ventricle mass (LVM) with TTE was calculated and indexed by height2.7(LVMI2.7) and weight (LVMIw). We report the prevalence of TTE-LVH using three methods: (1) calculating percentiles age- and sex- specific with values >95th percentile identifying LVH; (2) LVMI2.7>51 g/m2.7; (3) LVMIw>3.4 g/weight.Results40 (13%) children showed LVMI values >95th percentile, 24 children (8%) an LVMI2.7>51 g/m2.7while 19 children (6%) an LVMIw>3.4 g/kg. LVH-ECG by Sokolow-Lyon index was present in five, three and three children respectively, with poor values of sensitivity (ranging from 13 to 16%), positive predictive value (from 11 to 18%) and high values of specificity (up to 92%). The effects of anthropometrics parameters on Sokolow-Lyon were analyzed and showed poor correlation.ConclusionECG is a poor screening test for detecting LVH in children. In clinical practice, TTE remains the only tool to be used to exclude LVH.

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