Construction and validation of a nomogram to predict left ventricular hypertrophy in low‐risk patients with hypertension

Abstract

Electrocardiography (ECG) is an accessible diagnostic tool for screening patients with hypertensive left ventricular hypertrophy (LVH). However, its diagnostic sensitivity is low, with a high probability of false‐negatives. Thus, this study aimed to establish a clinically useful nomogram to supplement the assessment of LVH in patients with hypertension and without ECG‐LVH based on Cornell product criteria (low‐risk hypertensive population). A cross‐sectional dataset was used for model construction and divided into development (n = 2906) and verification (n = 1447) datasets. A multivariable logistic regression risk model and nomogram were developed after screening for risk factors. Of the 4353 low‐risk hypertensive patients, 673 (15.4%) had LVH diagnosed by echocardiography (Echo‐LVH). Eleven risk factors were identified: hypertension awareness, duration of hypertension, age, sex, high waist‐hip ratio, education level, tea consumption, hypochloremia, and other ECG‐LVH diagnostic criteria (including Sokolow–Lyon, Sokolow–Lyon products, and Peguero–Lo Presti). For the development and validation datasets, the areas under the curve were 0.724 (sensitivity = 0.606) and 0.700 (sensitivity = 0.663), respectively. After including blood pressure, the areas under the curve were 0.735 (sensitivity = 0.734) and 0.716 (sensitivity = 0.718), respectively. This novel nomogram had a good predictive ability and may be used to assess the Echo‐LVH risk in patients with hypertension and without ECG‐LVH based on Cornell product criteria.