Relation of Left Ventricular Mass and QT Dispersion in Patients With Systematic Hypertension

Ichkhan, Khachig; Molnár, J.; Somberg, John C.

doi:10.1016/s0002-9149(96)00797-7

Cited by 86 publications

(52 citation statements)

References 17 publications

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“…The strength of the relationship between QT interval parameters and echocardiographic LVM demonstrated here (r ¼ 0.26-0.27, for interval dispersions) is lower than that reported in some studies, 14,16,17,34 but equivalent to or higher than that reported in others. 15,19,35,36 It should be recognized, however, that the relationships between QT parameters and LVM observed in all studies, with few exceptions, 34,37 were fairly weak.…”

Section: Discussioncontrasting

confidence: 82%

“…15,19,35,36 It should be recognized, however, that the relationships between QT parameters and LVM observed in all studies, with few exceptions, 34,37 were fairly weak. Only two other investigations 14,19 specifically addressed the question of whether QT parameters could be used to identify hypertensive patients at risk of having LVH, that is, as a screening procedure for detection of LVH.…”

Section: Discussionmentioning

confidence: 75%

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Multivariate associates of QT interval parameters in diabetic patients with arterial hypertension: importance of left ventricular mass and geometric patterns

2003

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The aim of the study was to assess the determinants of increased QT interval parameters in diabetic patients with arterial hypertension and, in particular, the strength of their relationships to echocardiographically derived left ventricular mass (LVM) and geometric patterns. In a cross-sectional study with 289 hypertensive type 2 diabetic outpatients, maximal QT and QT c (heart ratecorrected) intervals, and QT, QT c , and number-of-leadsadjusted QT interval dispersions were manually measured from standard baseline 12-lead ECGs. Electrocardiographic criteria for left ventricular hypertrophy (LVH) were either Sokolow-Lyon or Cornell sex-specific voltages. LVM and geometric patterns were determined by 2D echocardiography. Statistical analyses involved bivariate tests (Mann-Whitney, v 2 , Spearman's correlation coefficients, ANOVA and receiver-operating-characteristic (ROC) curve analyses) and multivariate tests (multiple linear and logistic regressions). QT dispersion measurements showed significant correlations with echocardiographic LVM (r ¼ 0.26-0.27). ROC curves demonstrated a poor isolated predictive performance of all QT parameters for detection of LVH (areas under curve: 0.58-0.59), comparable to that of electrocardiographic voltage criteria. Only patients with concentric hypertrophy had significantly increased QT dispersion (QT d ) when compared to those with normal geometries (64.24 7 21.09 vs 53.20 7 15.35, Po0.05). In multivariate analyses, both electrocardiographic and echocardiographic LVH were independent predictors of increased QT d , as well as only QT d and gender were determinants of LVM. In conclusion, increased QT interval dispersion is associated with LVM and concentric hypertrophy geometric pattern in diabetic hypertensive patients, although in isolation neither QT d nor any QT parameter presents enough predictive performance to be recommended as screening procedures for detection of LVH.

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Section: Discussioncontrasting

confidence: 82%

Section: Discussionmentioning

confidence: 75%

Multivariate associates of QT interval parameters in diabetic patients with arterial hypertension: importance of left ventricular mass and geometric patterns

2003

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“…10 Echo-LVH has also been shown to be associated with increased risk of sudden death, 11 probably via the development of ventricular arrhythmias, 12 which may itself be related to the increased QTc dispersion demonstrated on the electrocardiogram of patients with LVH. 13,14 Echocardiography has thus become the current 'gold standard' for detection of LVH, despite some minor variations in recorded prevalence of LVH when differing echocardiographic diagnostic criteria are employed. 15 However, the high prevalence of hypertension in the community and the relatively limited provision of open-access echocardiography services (at least in the United Kingdom) may currently prevent many general practitioners from obtaining echocardiographic information on the majority of their hypertensive patients and, unless the situation changes, they shall need to continue to rely on the ECG for diagnosis of LVH.…”

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confidence: 99%

The ECG and left ventricular hypertrophy in primary care hypertensives

Conway

Lip

2001

J Hum Hypertens

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Keywords: ECG; left ventricular hypertrophy; primary care hypertensivesWhilst cardiac hypertrophy is initially a compensatory response to the high blood pressure, the increased muscle mass outstrips its oxygen supply and coupled with the reduced coronary vascular reserve seen in hypertension, results in myocardial ischaemia even with normal coronary arteries. Thus beyond a certain point, left ventricular hypertrophy (LVH) secondary to hypertension becomes a major risk factor for myocardial infarction, stroke, sudden death, and congestive cardiac failure, 1 and this increased risk is in addition to that imposed by hypertension itself. Furthermore, hypertensives with LVH are at increased risk of cardiac arrhythmias (atrial fibrillation, ventricular arrhythmias) and atherosclerotic vascular disease (coronary and peripheral artery disease). 1 Patients with hypertension and LVH should therefore be identified for aggressive management, not only of blood pressure, but of all their cardiovascular risk factors.Epidemiological data regarding prevalence of LVH and the increased risk of cardiovascular mortality and morbidity was initially provided by the Framingham Heart Study more than 30 years ago, which employed ECG criteria to define LVH. 2 Conversely, the association between hypertension and LVH is also well-established, 3 leading to a particularly high cardiovascular risk for the uncontrolled hypertensive via the development of LVH. However, the correlation between blood pressures measured in the clinical environment and left ventricular mass is poor. 4 By contrast, 24-h ambulatory blood pressure monitoring (ABPM) provides a closer correlation between average daytime arterial blood pressure and left ventricular mass. 5 Many different criteria for identifying LVH exist, based on both echocardiographic (echo-LVH) and electrocardiographic (ECG-LVH) features, but there is considerable variation in sensitivity and specificity between these methods. 1,6,7 A commonly used screening test for LVH in hypertensives uses the 12-lead ECG and the Sokolow and Lyon criteria, that is, the sum of the S wave in lead V1 and the R wave in leads V5 or V6 on the ECG Ͼ35 mm, with a sensitivity of 22% and specificity of 79%. Other methods have also been evaluated: 6-9 (i) The Romhilt-Estes Point-Score System of у4 has a sensitivity of 12% and specificity of 87%; (ii) The Cornell system has a sensitivity of 31% and specificity of 87%; (iii) the Sokolow-Lyon Index (RaVL у1.1 mV) has a sensitivity of 18% and specificity of 92%; and (iv) the Rodrigez Padial system has a sensitivity of 82% and specificity of 8% respectively. These figures suggest that most forms of interpreting the ECG with regards to LVH are not useful as a screening tool. This can be marginally improved by multiplying QRS-voltage by QRS-duration, thus increasing the specificity to 96% and sensitivity to about 50%. 6,7 Crudely speaking, the features of LVH on ECG normally mean that true LVH is present, but its absence does not mean that LVH is absent. Nevertheless, the specificit...

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“…Increased QTd has been shown to correlate positively to complex VA in many clinical conditions [17,20]. QTd and QTi correlate with the left ventricular mass index (LVMI) determined echocardiographically in a group of selected patients with essential hypertension [19,21,22]. Normal QTd values vary extensively from 10 to 71 ms. QTd is higher in cardiac patients in comparison to normal subjects.…”

Section: Qt Interval and Qt Dispersionmentioning

confidence: 99%

Influence of Patern and Degree of Left Ventricular Hypertrophy on Cardiac Arrhythmias

Kunišek¹

2012

Cardiac Arrhythmias - New Considerations

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Relation of Left Ventricular Mass and QT Dispersion in Patients With Systematic Hypertension

Cited by 86 publications

References 17 publications

Multivariate associates of QT interval parameters in diabetic patients with arterial hypertension: importance of left ventricular mass and geometric patterns

Multivariate associates of QT interval parameters in diabetic patients with arterial hypertension: importance of left ventricular mass and geometric patterns

The ECG and left ventricular hypertrophy in primary care hypertensives

Influence of Patern and Degree of Left Ventricular Hypertrophy on Cardiac Arrhythmias

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