Changing role of ECG in the evaluation left ventricular hypertrophy

Bachárová, Ljuba; Estes, E. Harvey; Hill, Joseph A.; Pahlm, Olle; Schillaci, Giuseppe; Strauss, David G.; Wagner, Galen S.

doi:10.1016/j.jelectrocard.2012.08.010

Cited by 10 publications

(8 citation statements)

References 14 publications

(7 reference statements)

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“…Body size, age, sex, and chest impedance may interfere with ECG markers of LVH, thus reducing the accuracy of voltage‐based criteria. Therefore, ECG and ECHO offer complementary information on cardiac hypertrophy by reflecting different pathological alterations at the cardiac level . Few studies have previously analyzed the additive value of ECG and ECHO in refining prediction of CV events.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, ECG and ECHO offer complementary information on cardiac hypertrophy by reflecting different pathological alterations at the cardiac level. 32 Few studies have previously analyzed the additive value of ECG and ECHO in refining prediction of CV events. This question has been addressed in different clinical settings, including in elderly men from a general population, 14 in American Indians with a high prevalence of type 2 diabetes, 15 in patients with previous ischemic stroke, 33 and in hypertensive patients with ECG LVH.…”

Section: Discussionmentioning

confidence: 99%

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Do Combined Electrocardiographic and Echocardiographic Markers of Left Ventricular Hypertrophy Improve Cardiovascular Risk Estimation?

Cuspidi

Facchetti

Sala

et al. 2016

J of Clinical Hypertension

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The authors estimated the risk of cardiovascular mortality associated with echocardiographic (ECHO) left ventricular hypertrophy (LVH) and subtypes of this phenotype in patients with and without electrocardiographic (ECG) LVH. A total of 1691 representatives of the general population were included in the analysis. Left ventricular (LV) hypertrophy (LVH) as detected by electrocardiography (ECG) or echocardiography (ECHO) is a powerful predictor of nonfatal and fatal cardiovascular (CV) events and all-cause death in a variety of clinical settings.1-5 Standard ECG is regarded as the first-line method for detecting LVH, owing to its large availability, good reproducibility, and limited cost. 6 In addition to these strengths, ECG provides clinically relevant information on cardiac rhythm, myocardial ischemia, ventricular "strain," and conduction alterations. 7Numerous observational studies and randomized trials have shown that regression-reduction of ECG LVH is associated with a lower likelihood of incident CV disease and all-cause mortality. 8,9 Hence, hypertension guidelines support LVH detection by ECG at the initial workup and during treatment of hypertensive patients as a useful tool for improving CV risk estimation and treatment.6 A strong line of evidence, however, indicates that ECG criteria for detecting LVH have an unsatisfactory sensitivity, as proven by studies where cardiac mass was also estimated by ECHO 10,11 or by more sophisticated imaging techniques such as computerized tomography and magnetic resonance imaging. 12The array of clinical and prognostic information provided by ECHO (LV geometry, global systolic/ diastolic function, regional kinesis, left atrial size, aortic diameter, and chamber mechanics), in addition to its superior accuracy for detecting LVH compared with standard ECG, are strong arguments for considering ECG findings of limited relevance in the evaluation of CV risk in clinical practice. 13Whether the increased risk is related to isolated ECHO LVH or ECG LVH is well documented, but the additional prognostic value provided by LVH positivity on both tests has been addressed by few studies in the general population. 14,15Therefore, we aimed to investigate whether patients from a general population with LVH according to both tests have a higher risk of CV mortality than patients with LVH according to either ECG or ECHO. Furthermore, we extended, for the first time, such investigation to subtypes of ECHO LVH, as defined by the updated classification suggested by the Dallas Heart Study investigators based on four patterns: eccentric nondilated, eccentric dilated, concentric nondilated, and concentric dilated LVH. 16 To this purpose we have analyzed the data obtained in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, 16 a population study performed in a north region of Italy. METHODS PopulationThe PAMELA study was carried out in a sample of 3200 patients representative of the population of Monza (a town near Milan, Italy) for sex and age decades (25-74 years). The ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Do Combined Electrocardiographic and Echocardiographic Markers of Left Ventricular Hypertrophy Improve Cardiovascular Risk Estimation?

Cuspidi

Facchetti

Sala

et al. 2016

J of Clinical Hypertension

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“…First, the limited diagnostic performance of ECG criteria for detecting anatomical changes present in LVH may likely be related to the inherent differences between electrophysiology and anatomy. Second, the term LVER has been suggested to be more appropriate when referring to the electrical changes present in LVH (144,145). We therefore considered it a reasonable approach to define LVER in terms of electrical changes in the myocardium based on deviation from normality observed in healthy individuals, rather than based on a non-electrical anatomical marker such as LVH.…”

Section: Left Ventricular Electrical Remodeling -Diagnosis and Prognomentioning

confidence: 99%

The electrical determinants of increased wall thickness and mass in left ventricular hypertrophy

Maanja

Schlegel

Kozor

et al. 2020

Journal of Electrocardiology

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“…The copyright holder for this preprint this version posted January 10, 2022. ; https://doi.org/10.1101/2022.01. 10.22268661 doi: medRxiv preprint observations inspired the hypothesis that the vectorcardiographic QRS-T angle could provide diagnostic value beyond those of conventional ECG criteria for LVH. Therefore, the aims of this study were to a) propose a sex-specific upper limit of normal for the spatial peaks QRS-T angle derived from the resting 12-lead ECG, and b) investigate the diagnostic and prognostic performance of the QRS-T angle compared to conventional ECG criteria for LVH.…”

Section: Introductionmentioning

confidence: 99%

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

Maanja

Schlegel

Kozor

et al. 2022

Preprint

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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.

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Changing role of ECG in the evaluation left ventricular hypertrophy

Cited by 10 publications

References 14 publications

Do Combined Electrocardiographic and Echocardiographic Markers of Left Ventricular Hypertrophy Improve Cardiovascular Risk Estimation?

Do Combined Electrocardiographic and Echocardiographic Markers of Left Ventricular Hypertrophy Improve Cardiovascular Risk Estimation?

The electrical determinants of increased wall thickness and mass in left ventricular hypertrophy

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

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