Detection of left ventricular hypertrophy by the R-wave voltage in lead aVL: population-based study

Rodrigues, Sérgio Lamêgo; Ângelo, Lílian Cláudia Souza; Baldo, Marcelo Perim; Dantas, Eduardo Miranda; Barcelos, Alexandre Maulaz; Pereira, Alexandre C.; Krieger, José Eduardo; Mill, José Geraldo

doi:10.1007/s00392-013-0578-x

Cited by 15 publications

(6 citation statements)

References 35 publications

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“…By using nuclear magnetic resonance as gold standard, Courand et al 28 concluded that the voltage of R wave in aVL lead between 0.5 and 1 mV was a strong indicator of left ventricular hypertrophy. Similarly, Rodrigues et al 29 recognized that the voltage of R wave in aVL lead ≥0.55 mV had good sensitivity (87%) for detecting LVH with preserved specificity (75%). This study showed no positive results of LVH based on R wave voltage (> 1.1 mV) in aVL lead at patients without adverse events, while it was present in 12.5% patients with composite events.…”

Section: Discussionmentioning

confidence: 92%

Electrocardiographic criteria which have the best prognostic significance in hypertensive patients with echocardiographic hypertrophy of left ventricle: 15‐year prospective study

Djordjević

Tasić

Kostić³

et al. 2020

Clinical Cardiology

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Background Electrocardiography is the first‐choice technique for detecting left ventricular hypertrophy in patients with arterial hypertension. It is necessary to know the probable outcome for every patient during the treatment, with the aim of improving cardiovascular event prevention. Hypothesis Certain electrocardiographic criteria for left ventricular hypertrophy may predict outcomes of patients with left ventricular hypertrophy during a 15‐year follow‐up. Methods Fifteen‐year prospective study of 83 consecutive patients (53 male and 30 female; mean age 55.3 ± 8.1) with echocardiographic left ventricular hypertrophy (left ventricular mass index 170.3 ± 31.6 g/m2). Electrocardiographic left ventricular hypertrophy was determined by means of Gubner‐Ungerleider voltage, Lewis voltage, voltage of R wave in aVL lead, Lyon‐Sokolow voltage, Cornell voltage and Cornell product, voltage RV6 and RV5 ratio, Romhilt‐Estes score, Framingham criterion and Perugia criterion. Results One or more composite events were registered in 32 (38.5%) patients during 15‐year follow‐up. Positive Lyon‐Sokolow score (17.6% vs. 47.3%; P < 0.05), Lewis voltage (9.8% vs. 21.9%; P < 0.05), Cornell voltage (15.7% vs. 37.5%; P < 0.05), and Cornell product (9.8% vs. 34.4%; P < 0.01) were more frequent in a group of patients with composite events. Odd ratio for Cornell product was 4.819 (95% CI 1.486‐15.627). Conclusion Patients with echocardiographic left ventricular hypertrophy who had positive Lewis voltage, Lyon‐Sokolow voltage, Cornell voltage, and Cornell product showed worse 15‐year outcome. The strongest predictor of cardiovascular events was positive result of Cornell product.

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Section: Discussionmentioning

confidence: 92%

Electrocardiographic criteria which have the best prognostic significance in hypertensive patients with echocardiographic hypertrophy of left ventricle: 15‐year prospective study

Djordjević

Tasić

Kostić³

et al. 2020

Clinical Cardiology

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“…Interestingly, this threshold was validated in an independent cohort with a slightly different risk profiles, strengthening the validity of our conclusion. In addition, a threshold of 0.6 or 0.55 mV has already been proposed as the best compromise between sensitivity and specificity in detecting LVH by TTE [10,11]. In another study by our group, the optimal RaVL cutoff for detecting cardiac MRI LVH was 0.65 mV [20].…”

Section: Discussionmentioning

confidence: 96%

“…The voltage of R wave in lead aVL (RaVL), a component of the Cornell index, has several advantages: it is simple to measure and reproducible [10] and has been shown more tightly correlated with left ventricular mass (LVM), as assessed by TTE, than Sokolow or Cornell indexes [10,11]. In addition to that, two studies have demonstrated that RaVL predicts major cardiovascular events in hypertensive patients with or without LVH on ECG [10,12].…”

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confidence: 98%

R wave in aVL lead

Courand

Jenck

Bricca

et al. 2014

Journal of Hypertension

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“…However, the American Electrocardiogram Committee opined: “Published studies are currently insufficient to indicate whether any of the more recently proposed criteria are clearly superior to the others or are simply redundant.” [7] Furthermore, the various ECG criteria have high specificity, but low sensitivity [8]. Consequently, different modifications in the use of ECG have been proposed [9, 10]. With the various uncertainties, the use of ECG can be compromised.…”

Section: Introductionmentioning

confidence: 99%

Models for improved diagnosis of left ventricular hypertrophy based on conventional electrocardiographic criteria

Zhu

Yang

et al. 2017

BMC Cardiovasc Disord

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BackgroundElectrocardiogram (ECG) is commonly used clinically due to convenience, but its accuracy is insufficient for left ventricular hypertrophy (LVH) diagnosis. In this study, we attempted to improve diagnostic accuracy of LVH by establishing models with ECG parameters.MethodsEighty hundred and twenty eight patients were recruited in the present study which were divided into groups according to gender, age and body mass index (BMI). The sensitivity, specificity, Youden index, positive predictive value, negative predictive value and accuracy were calculated using ultrasonic cardiogram criteria of LVH as the gold standard. Area under the curve was also calculated to assess the diagnostic accuracy of 22 conventional ECG criteria in different groups. Stepwise discriminant analyses were performed to establish models of ECG for LVH.ResultsThe diagnostic accuracy of ECG11 (S V2 + R V5,6) and ECG12 (S V1,2 + R V5,6) was significantly higher than the other 20 criteria, while ECG15 (R V5/R V6) was lowest. The ECG12 sensitivity for males was 52.5%, for <60 years old was 44.2%, and for BMI <25 kg/m2 was 46.2%,higher than for females (27.5%), for ≧60 years old (35.7%), and for BMI ≧25 kg/m2(27.6%), respectively. The difference between genders was the most obvious. Based on these observations, the following models for males and females were established:andrespectively. The sensitivities of the two new models were 71.4% and 75.8%, significantly higher than the22 conventional ECG criteria.ConclusionTwo models developed based on gender can be considered for use to investigate the preliminary assessment of the probability of LVH.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0637-8) contains supplementary material, which is available to authorized users.

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Detection of left ventricular hypertrophy by the R-wave voltage in lead aVL: population-based study

Abstract: We have shown that the simple and single assessment of RaVL presented a greater diagnostic ability in detecting ECHO-LVH in the general population, signaling its value mainly as a screening tool.

Cited by 15 publications

References 35 publications

Electrocardiographic criteria which have the best prognostic significance in hypertensive patients with echocardiographic hypertrophy of left ventricle: 15‐year prospective study

Electrocardiographic criteria which have the best prognostic significance in hypertensive patients with echocardiographic hypertrophy of left ventricle: 15‐year prospective study

R wave in aVL lead

Models for improved diagnosis of left ventricular hypertrophy based on conventional electrocardiographic criteria

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