Relation of Electrocardiographic Criteria for Left Atrial Enlargement to Two-Dimensional Echocardiographic Left Atrial Volume Measurements

Lee, Kwan S.; Appleton, Christopher P.; Lester, Steven J.; Adam, Terrence J.; Hurst, R. Todd; Moreno, Carlos A.; Altemose, Gregory T.

doi:10.1016/j.amjcard.2006.07.073

Cited by 53 publications

(59 citation statements)

References 30 publications

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“…Regarding individual ECG criteria, we found higher sensitivity for P wave >110ms compared to previous echocardiographic studies(9)(10)(12)(25). We demonstrate higher sensitivity for P mitrale and NPTF-V1 > 40ms·mm compared to the most recent echocardiographic study of 261 randomly selected patients, which calculated LAV using a similar biplane atrial volume analysis from 2-dimensional echocardiography (36). Our findings are similar to those of Tsao et al who performed ECG-CMR correlation, albeit in unselected patients (14).…”

Section: Discussionsupporting

confidence: 81%

Electrocardiographic detection of hypertensive left atrial enlargement in the presence of obesity: re-calibration against cardiac magnetic resonance

et al. 2016

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Left atrial enlargement (LAE) has adverse prognostic implications in hypertension.We sought to determine the accuracy of 5 ECG criteria for LAE in hypertension relative to cardiac magnetic resonance (CMR) gold-standard, and investigate the effect of concomitant obesity. 130 consecutive patients (age: 51.4 ± 15.1 years, 47% male, 51% obese, systolic blood pressure: 171 ± 29mmHg, diastolic blood pressure: 97 ± 15mmHg) referred for CMR (1.5T) from a tertiary hypertension clinic were included. Patients with concomitant cardiac pathology were excluded. ECGs were assessed blindly for: 1) P wave >110ms, 2) P mitrale, 3) P wave axis <30°, 4) Area of negative P terminal force in V1 >40ms·mm and 5) Positive P terminal force in aVL >0.5mm. LA volume ≥55ml/m 2 , measured blindly by CMR, was defined as LAE.Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and area under the receiver operator curve were calculated. The prevalence of LAE by CMR was 26%. All the individual ECG LAE criteria were more specific than sensitive, with specificities ranging from 70% (P axis <30 o ) to 99% (P mitrale). Obesity attenuated the specificity of most of the individual ECG LAE criteria. Obesity correlated with significant lower specificity (48% vs 65%, P < 0.05) and a trend towards lower sensitivity (59% vs 43%, P = 0.119) when ≥1 ECG LAE criteria were present. Individual ECG criteria of LAE in hypertension are specific, but not sensitive, at identifying LAE. The ECG should not be used to excluded LAE in hypertension, particularly in obese subjects.

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Section: Discussionsupporting

confidence: 81%

Electrocardiographic detection of hypertensive left atrial enlargement in the presence of obesity: re-calibration against cardiac magnetic resonance

et al. 2016

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“…Although the 12-lead surface ECG has been shown to be useful for predicting AF in patients without ARVD, 13,27 ECG parameters of atrial dilation have generally been limited by poor sensitivity despite good specificity. 28 Although we used ECG definitions for atrial enlargement that have been validated by CMR, because of its high accuracy in volumetric assessment of cardiac chamber sizes, 14 we were unable to identify any ECG variable that significantly predicted atrial arrhythmia in our ARVD cohort.…”

Section: Study Populationmentioning

confidence: 89%

Clinical Role of Atrial Arrhythmias in Patients With Arrhythmogenic Right Ventricular Dysplasia

Saguner

Ganahl

Kraus

et al. 2014

Circ J

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“…ECG evidence of left atrial dilation was not significantly correlated with LHF. This may be due to suboptimal correlation with echocardiographic left atrial dilation [33,34], further affected by nonspecific P-wave changes due to severe right-sided atrial strain. It should be stressed that for accurate noninvasive predictions, the data from medical history, ECG and echocardiography need to be combined.…”

Section: Figurementioning

confidence: 99%

Noninvasive identification of left-sided heart failure in a population suspected of pulmonary arterial hypertension

et al. 2015

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Exclusion of pulmonary hypertension secondary to left-sided heart disease (left heart failure (LHF)) is pivotal in the diagnosis of pulmonary arterial hypertension (PAH). In case of doubt, invasive measurements are recommended. The aim of the present study was to investigate whether it is possible to diagnose LHF using noninvasive parameters in a population suspected of PAH. 300 PAH and 80 LHF patients attended our pulmonary hypertension clinic before August 2010, and were used to build the predictive model. 79 PAH and 55 LHF patients attended our clinic from August 2010, and were used for prospective validation.A medical history of left heart disease, S deflection in V1 plus R deflection in V6 in millimetres on ECG, and left atrial dilation or left valvular heart disease that is worse than mild on echocardiography were independent predictors of LHF. The derived risk score system showed good predictive characteristics: R 2 =0.66 and area under the curve 0.93. In patients with a risk score ⩾72, there is 100% certainty that the cause of pulmonary hypertension is LHF. Using this risk score system, the number of right heart catheterisations in LHF may be reduced by 20%.In a population referred under suspicion of PAH, a predictive model incorporating medical history, ECG and echocardiography data can diagnose LHF noninvasively in a substantial percentage of cases. @ERSpublications A risk score system can identify left-heart failure as alternative PH cause in patients suspected of PAH clinically http://ow.ly/JAIkR

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Relation of Electrocardiographic Criteria for Left Atrial Enlargement to Two-Dimensional Echocardiographic Left Atrial Volume Measurements

Cited by 53 publications

References 30 publications

Electrocardiographic detection of hypertensive left atrial enlargement in the presence of obesity: re-calibration against cardiac magnetic resonance

Electrocardiographic detection of hypertensive left atrial enlargement in the presence of obesity: re-calibration against cardiac magnetic resonance

Clinical Role of Atrial Arrhythmias in Patients With Arrhythmogenic Right Ventricular Dysplasia

Noninvasive identification of left-sided heart failure in a population suspected of pulmonary arterial hypertension

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