Short‐term repeatability of electrocardiographic criteria of left ventricular hypertrophy

Abstract

Background Left ventricular hypertrophy (LVH) is a marker of cardiac end‐organ damage and a risk factor for cardiovascular morbidity and mortality. Although clinical trials and cohort studies commonly use the electrocardiogram (ECG) for LVH assessment, the repeatability of ECG‐LVH criteria has not been sufficiently examined. Therefore, we evaluated the repeatability of ECG‐LVH criteria. Methods Participants (n = 63) underwent two standard ECGs at each of two visits, two weeks apart. The ECGs were processed centrally to calculate Cornell voltage (CV) LVH, Cornell voltage product (CVP) LVH, Sokolow–Lyon (SL) LVH, and Sokolow–Lyon product (SLP) LVH. We also used the waveforms measurements contributing to these LVH criteria as continuous variables, referred to here as CV‐index, CVP‐index, and SL‐index. We calculated the intraclass correlation coefficient (ICC), minimal detectable change (95% confidence), and the prevalence‐adjusted bias‐adjusted kappa (PABAK). Results ICCs (95% confidence intervals (CI)) were 0.97 (0.96, 0.98) for CV‐index, 0.97 (0.95, 0.98) for CVP‐index, and 0.93 (0.90, 0.96) for log of SL‐index. Minimal detectable change between repeat measures of CV‐index, CVP‐index, and log of SL‐index were ≥236.7 mV, ≥26.7 mV, and ≥0.09 mV, respectively. The within‐visit PABAK was 1 for all ECG‐LVH criteria, except for the first visit SLP‐LVH (PABAK = 0.93). Between‐visit PABAK ranged from 0.83 to 0.97 across LVH criteria. Conclusions CV, CVP, and SL ECG‐LVH as continuous variables have excellent repeatability, and as binary variables have excellent within‐visit agreement and good between‐visit agreement. These results alleviate concerns about the repeatability the ECG‐LVH use in clinical trials and epidemiologic studies.

Short‐term repeatability of the peguero‐lo presti electrocardiographic left ventricular hypertrophy criteria

“…The Cornell voltage is currently one of the most widely used ECG indices of LVH. In the same study population, we previously reported that the ICC for the continuous Cornell voltage index was 0.97 (95% CI: 0.96–0.98) (Meyer et al., 2020). When comparing to the Peguero‐Lo Presti index, the Cornell voltage index showed similar repeatability (determined by the overlapping 95% confidence intervals).…”

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

“…Left ventricular mass is measured by accurate techniques, such as echocardiography, computerized tomography, magnetic resonance, and three‐dimensional echocardiography. Electrocardiography (ECG) is the first‐choice technique for detecting left ventricular hypertrophy (LVH) in patients with hypertension due to its wide‐scale availability, low cost, repeatability, and established value prognostic 1‐3 . Current guidelines for diagnosis and treatment of hypertension strongly recommend ECG as the only examination to be performed in all hypertensive subjects for detection of LVH 4 .…”