R Wave in aVL Lead Is a Robust Index of Left Ventricular Hypertrophy: A Cardiac MRI Study

Courand, Pierre‐Yves; Grandjean, Adrien; Charles, Paul; Paget, Vinciane; Khettab, Fouad; Bricca, Giampiero; Boussel, Loîc; Lantelme, Pierre; Harbaoui, Brahim

doi:10.1093/ajh/hpu268

Cited by 19 publications

(13 citation statements)

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“…TOD was assessed at three levels: heart (LVH using 12-lead ECG and TTE), vessels (PWV > 10 m/s) and kidney (MDRD estimated glomerular filtration rate (eGFR) < 60 mL/ min/1.73 m 2 or microalbuminuria > 30 mg/day) for renal damage. 1,[11][12][13] The protocol is detailed in the supplementary data (available online). Table 1 summarizes the baseline characteristics of our cohort.…”

Section: Methodsmentioning

confidence: 99%

Plasma NT-proBNP mirrors the deleterious cardiovascular and renal continuum in hypertension

Courand

Harbaoui

Bècle

et al. 2016

Eur J Prev Cardiolog

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Background The aims of this study were (a) to test the ability of N-terminal pro-brain natriuretic peptide (NT-proBNP) to detect subclinical target organ damage (TOD) denoted by left ventricular hypertrophy (LVH), aortic stiffness or renal damage and (b) to test its reproducibility in two different conditions in an ancillary study. Methods The study included 837 patients (50.9% men) with hypertension aged 50 ± 24 years with a median 24-h ambulatory blood pressure (BP) of 148/90 mmHg. LVH was assessed by transthoracic echocardiography and echocardiography, aortic stiffness was assessed by carotid-femoral pulse wave (PWV) measurements and renal dysfunction by measurements of the estimated glomerular filtration rate (eGFR) and microalbuminuria. Results After the exclusion of patients with a history of heart failure, NT-proBNP was independently correlated with sex, systolic BP, primary hypertension, PWV, LVH and eGFR, but not with microalbuminuria. The median (interquartile range) NT-proBNP increased gradually according to the number of target organs damaged: 42 (24-70), 77 (39-151), 141 (81-250) and 334 (177-556) pg/mL, for damage to 0, 1, 2 and 3 target organs, respectively ( p < 0.001). . For the same number of target organs damaged, NT-proBNP was higher in women and for secondary hypertension. A threshold at 90 pg/mL for men and 142 pg/mL in women had a specificity of 95% to detect at least one TOD (areas under ROC curve 0.790 and 0.783, respectively). The reproducibility of NT-proBNP was fairly good in this setting ( r = 0.952, p < 0.001, N = 325) Conclusion This study demonstrates that NT-proBNP mirrors the harmful effect of high BP on TOD. NT-proBNP could be used as an integrative tool for risk stratification in hypertension.

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Section: Methodsmentioning

confidence: 99%

Plasma NT-proBNP mirrors the deleterious cardiovascular and renal continuum in hypertension

Courand

Harbaoui

Bècle

et al. 2016

Eur J Prev Cardiolog

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“…No patient was treated with the combination of encorafenib-binimetinib. The median duration of treatment was 9 months (IQR [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]). 30 patients (34.1%) had a rechallenge after progressive disease under previous treatment with BRAF and/or MEKis.…”

Section: Baseline Characteristics Of Study Populationmentioning

confidence: 99%

“…8 months (IQR [6][7][8][9]) for patients whose BRAF and/or MEKis were discontinued, and 7 months (IQR [6][7][8][9][10][11][12][13][14][15][16]) for the others. All patients who benefited from a specific treatment had a normalization of LVEF at the end of follow-up.…”

Section: Management Of Patients With Lvef-dmentioning

confidence: 99%

Left ventricular ejection fraction decrease related to BRAF and/or MEK inhibitors in metastatic melanoma patients: A retrospective analysis

et al. 2020

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BRAF and MEKis have revolutionized the management of BRAF V600 -mutated melanoma patients. Left ventricular ejection fraction decrease (LVEF-D) related to these treatments has not been thoroughly evaluated to date. The main objective of this study was to describe characteristics of LVEF-D in melanoma patients treated with BRAF and/or MEKis. Metastatic melanoma patients treated with BRAF and/ or MEKis between March 1, 2012 and May 18, 2018 were included retrospectively (Lyon Sud University Hospital, Hospices Civils de Lyon). LVEF-D was defined as a reduction in LVEF ≥10% from baseline to a value <55%; normalization was defined as a value ≥55%. Among the 88 patients included, 12 (13.6%) experienced a LVEF-D, including 10 grade 2 and 2 grade 3. The median onset of which was 11 months (IQR [3-21]). No patient previously treated with beta-blockers (n = 12) experienced a LVEF-D. Analysis of laboratory parameters, electrocardiogram, and transthoracic echocardiography during the follow-up did not find any predictive marker of LVEF-D. All patients who benefited from a specific treatment of LVEF-D had a normalization of LVEF at the end of follow-up. LVEF recovery was significantly better for patients treated with angiotensin converting enzyme inhibitors and beta-blockers than those who did not (P = .019). Ophthalmological adverse events were significantly more frequent in patients who experienced a LVEF-D (P = .006) and the latter did not influence overall-survival (P = .117) or progression-free-survival (P = .297). LVEF-D is a common and easily manageable adverse event due to BRAF and MEKis. Its association with ocular toxicity suggests a close ophthalmological monitoring when LVEF-D occurs. K E Y W O R D Sadverse events, BRAF inhibitor, cardiac toxicity, heart failure, left ventricular ejection fraction, left ventricular systolic dysfunction, MEK inhibitor, metastatic melanoma 2612 | BERGER Et al.

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“…Complexity and low presence in the first hypertrophy made it unfit for routine application. 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%).…”

Section: Discussionmentioning

confidence: 99%

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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R Wave in aVL Lead Is a Robust Index of Left Ventricular Hypertrophy: A Cardiac MRI Study

Abstract: Our results showed that RaVL is a good index of LVH with a univocal threshold of 1.0 mV in various clinical conditions. SV3 may be combined to RaVL in some conditions, namely LV enlargement to increase its performance.

Cited by 19 publications

References 35 publications

Plasma NT-proBNP mirrors the deleterious cardiovascular and renal continuum in hypertension

Plasma NT-proBNP mirrors the deleterious cardiovascular and renal continuum in hypertension

Left ventricular ejection fraction decrease related to BRAF and/or MEK inhibitors in metastatic melanoma patients: A retrospective analysis

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

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