Racial differences in the ECG — selected aspects

Macfarlane, Peter W.; Katibi, Ibraheem; Hamde, Satish T.; Singh, Dilbag; Clark, Elaine; Devine, Brian; Francq, Bernard; Lloyd, Suzanne M.; Kumar, Vinod

doi:10.1016/j.jelectrocard.2014.08.003

Cited by 47 publications

(30 citation statements)

References 14 publications

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“…It would be worthwhile considering race dependence when investigating new criteria for LVH given that blacks for example tend to have higher QRS amplitudes than Caucasians [8]. Indeed, black females appear to have an increasing Sokolow-Lyon index with advancing age [8].…”

Section: Discusssionmentioning

confidence: 99%

Specificity of New Diagnostic Criteria for Left Ventricular Hypertrophy

Clark¹,

Macfarlane²

2017

Computing in Cardiology Conference (CinC)

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IntroductionOver the years, various electrocardiographic criteria for left ventricular hypertrophy (LVH) have been developed. The more widely used criteria are the Romhilt-Estes scoring system [1], the Sokolow-Lyon index [2] and the Cornell voltage criterion [3]. Sensitivity is generally low for all criteria but specificity varies from being acceptable to poor. For this reason, new criteria are sought. Due to the small numbers of patients used in studies on proposed criteria, the results obtained can sometimes be misleading.A recent publication proposed a new criterion, namely the Peguero/Lo Presti ECG criterion for LVH [4]. The criterion was:Max S wave amplitude + S wave amplitude in V4 > 2.8mV for males or 2.3mV for females.In their paper, the authors reported an improved sensitivity index (62%) compared to more commonly used criteria, as well as a high specificity (90%). The population used for the study consisted of a small number of patients (47 males, 47 females, mean age 54±17 years) with LVH proven by echocardiography and a similar number of patients in a control group (59 males, 63 females, mean age 68±15 years). The authors listed the small sample size as a limitation of the study.The aim of the present study was to assess the specificity of the new criterion on a larger study population of healthy individuals, with particular attention to the value of the index for different age groups within each gender group. MethodsA dataset of apparently healthy Caucasian adults was used in the study. 1496 ECGs were analysed of which 859 were from males). The age range of the cohort was 18 to 82 years. The ECGs were analysed using version 28 of the University of Glasgow 12 Lead resting ECG analysis program (Glasgow program) [5]. The required wave measurements were extracted and the new Peguero/Lo Presti index was calculated. The SokolowLyon index (SV1 + RV5 amplitude) and the Cornell voltage (SV3 + RaVL amplitude) were also calculated.ECGs were sub-divided into age groups for males and females, namely 18-29, 30-39, 40-49 and ≥50 years. Counts were made of the number of cases that met the required thresholds for each index within each age and sex category within the Glasgow program, and resulting specificity was noted. Counts were also obtained of the number of cases that reported LVH using the Glasgow criteria. The Glasgow program uses a combination of the Romhilt-Estes criteria and the Cornell criteria. ResultsThe specificity values are shown in Table 1. The numbers of cases meeting the Peguero/Lo Presti criterion is high in the age groups 18-29 and 30-39 years. Of the 417 females under 40, 99 (23.7%) met the criteria. Of the 448 males, 199 (44.4%) met the criteria.

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Section: Discusssionmentioning

confidence: 99%

Specificity of New Diagnostic Criteria for Left Ventricular Hypertrophy

Clark¹,

Macfarlane²

2017

Computing in Cardiology Conference (CinC)

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“…Of importance is the fact that there is lack of data regarding the normal limits specific to a Latin American population. Given the frequent immigration of this population into North America and Europe and the known ECG variations in different populations [14], the study of the normal limits of the ECG in Latinos is of importance for medical staff around the world.…”

Section: Introductionmentioning

confidence: 99%

Normal limits of the electrocardiogram derived from a large database of Brazilian primary care patients

Palhares

Marcolino

Santos

et al. 2017

BMC Cardiovasc Disord

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BackgroundKnowledge of the normal limits of the electrocardiogram (ECG) is mandatory for establishing which patients have abnormal ECGs. No studies have assessed the reference standards for a Latin American population. Our aim was to establish the normal ranges of the ECG for pediatric and adult Brazilian primary care patients.MethodsThis retrospective observational study assessed all the consecutive 12-lead digital electrocardiograms of primary care patients at least 1 year old in Minas Gerais state, Brazil, recorded between 2010 and 2015. ECGs were excluded if there were technical problems, selected abnormalities were present or patients with selected self-declared comorbidities or on drug therapy. Only the first ECG from patients with multiple ECGs was accepted. The University of Glasgow ECG analysis program was used to automatically interpret the ECGs. For each variable, the 1st, 2nd, 50th, 98th and 99th percentiles were determined and results were compared to selected studies.ResultsA total of 1,493,905 ECGs were recorded. 1,007,891 were excluded and 486.014 were analyzed. This large study provided normal values for heart rate, P, QRS and T frontal axis, P and QRS overall duration, PR and QT overall intervals and QTc corrected by Hodges, Bazett, Fridericia and Framingham formulae. Overall, the results were similar to those from other studies performed in different populations but there were differences in extreme ages and specific measurements.ConclusionsThis study has provided reference values for Latinos of both sexes older than 1 year. Our results are comparable to studies performed in different populations.

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“…Most of these studies focused on a specific subpopulation, such as athletes or an elderly population, or included only women . Previous studies showed that interpretation of the ECG should be corrected for age categories, sex, and ethnicity …”

Section: Introductionmentioning

confidence: 99%

Population‐based values and abnormalities of the electrocardiogram in the general Dutch population: The LifeLines Cohort Study

Ende

Siland

Snieder

et al. 2017

Clinical Cardiology

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Background Our aim is to present average values and prevalence of electrocardiographic (ECG) abnormalities among the general Dutch population in the LifeLines Cohort. Hypothesis The ECG values previously studied in the Caucasian population of smaller cohorts will be confirmed with ECG data from LifeLines. Methods ECG data of 152 180 individuals age 18 to 93 years were available. Individuals with cardiovascular risk factors were excluded to analyze the healthy population. Average values of the ECG for the healthy population were presented as means with 95% and 99% confidence intervals and as medians with first and 99th percentiles. Results Median heart rate was highest in the youngest and oldest individuals of the healthy population. Median duration of P wave, PQ interval, and QRS duration were longer in males compared with females. In contrast, median QT interval corrected for heart rate was higher in females. In general, the above‐mentioned parameters increased with age. The prevalences of ECG abnormalities adjusted for the Dutch population were 0.9% for atrial fibrillation or flutter, 1.4% for premature atrial complexes, 0.5% for myocardial infarction, 2.1% for ventricular premature complexes, 1.0% for left ventricular hypertrophy, 8.1% for P‐R interval >200 ms, and 0.8% for bundle branch block. Conclusions Our study provides an overview of average values and ECG abnormalities and confirms data of previous smaller studies. In addition, we evaluate the age‐ and sex‐dependent normal limits of the P wave and QRS duration and confirm in detail the frontal plane QRS‐T angle on the ECG.

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Racial differences in the ECG — selected aspects

Cited by 47 publications

References 14 publications

Specificity of New Diagnostic Criteria for Left Ventricular Hypertrophy

Specificity of New Diagnostic Criteria for Left Ventricular Hypertrophy

Normal limits of the electrocardiogram derived from a large database of Brazilian primary care patients

Population‐based values and abnormalities of the electrocardiogram in the general Dutch population: The LifeLines Cohort Study

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