The Romhilt‐Estes electrocardiographic score predicts sudden cardiac arrest independent of left ventricular mass and ejection fraction

Darouian, Navid; Aro, Aapo L.; Narayanan, Kumar; Uy‐Evanado, Audrey; Rusinaru, Carmen; Reinier, Kyndaron; Gunson, Karen; Jui, Jonathan; Chugh, Sumeet S.

doi:10.1111/anec.12424

Cited by 10 publications

(3 citation statements)

References 39 publications

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“…In the Oregon SUDS, Sokolow-Lyon voltage was used as a dichotomous ECG LVH variable and was associated with sudden cardiac arrest also after adjusting for other risk factors, including echo LVH [8]. More recently in the Oregon SUDS, Romhilt-Estes score ≥5 ("definite LVH") was associated with sudden cardiac arrest in the adjusted model [39].…”

Section: Ecg Lvh and Anatomic Lvh In Relation To Scd Riskmentioning

confidence: 99%

ECG left ventricular hypertrophy as a risk predictor of sudden cardiac death

Porthan

Kenttä

Niiranen

et al. 2019

International Journal of Cardiology

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Background: Electrocardiographic (ECG) left ventricular hypertrophy (LVH) is an established risk factor for cardiovascular events. However, limited data is available on the prognostic values of different ECG LVH criteria specifically to sudden cardiac death (SCD). Our goal was to assess relationships of different ECG LVH criteria to SCD. Methods: Three traditional and clinically useful (Sokolow-Lyon, Cornell, R aVL) and a recently proposed (Peguero-Lo Presti) ECG LVH voltage criteria were measured in 5730 subjects in the Health 2000 Survey, a national general population cohort study. Relationships between LVH criteria, as well as their selected composites, to SCD were analyzed with Cox regression models. In addition, population-attributable fractions for LVH criteria were calculated. Results: After a mean follow-up of 12.5 ± 2.2 years, 134 SCDs had occurred. When used as continuous variables, all LVH criteria except for R aVL were associated with SCD in multivariable analyses. When single LVH criteria were used as dichotomous variables, only Cornell was significant after adjustments. The dichotomous composite of Sokolow-Lyon and Cornell was also significant after adjustments (hazard ratio for SCD 1.82, 95% confidence interval 1.20-2.70, P = 0.006) and was the only LVH measure that showed statistically significant populationattributable fraction (11.0%, 95% confidence interval 1.9-19.2%, P = 0.019). Conclusions: Sokolow-Lyon, Cornell, and Peguero-Lo Presti ECG, but not R aVL voltage, are associated with SCD risk as continuous ECG voltage LVH variables. When SCD risk assessment/adjustment is performed using a dichotomous ECG LVH measure, composite of Sokolow-Lyon and Cornell voltages is the preferred option.

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Section: Ecg Lvh and Anatomic Lvh In Relation To Scd Riskmentioning

confidence: 99%

ECG left ventricular hypertrophy as a risk predictor of sudden cardiac death

Porthan

Kenttä

Niiranen

et al. 2019

International Journal of Cardiology

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“…It also demonstrated that each of the six individual components of the R-E criteria has a unique and independent ability to predict different cardiovascular disease outcomes [16]. According to a study by Darouian N et al, R-E criteria have also shown a benefit in expecting sudden cardiac arrest if the score was ≥5, independent of echocardiographic LVH and reduced LV ejection fraction [17].…”

Section: Discussionmentioning

confidence: 96%

The Use of Romhilt-Estes Criteria in the Presumptive Electrocardiographic Diagnosis of Left Ventricular Hypertrophy in Comparison to Voltage-Based Criteria

Hamed¹,

Dasari²,

Casale³

et al. 2022

Cureus

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BackgroundThe ECG diagnosis of left ventricular hypertrophy (LVH) has been challenging for over a hundred years. ECG diagnosis of LVH has shown good specificity but lacks sensitivity. In addition, voltage-based criteria can be affected by multiple conditions such as obesity and chronic lung disease. Therefore, we sought to compare Romhilt-Estes (R-E) criteria with commonly used voltage-based criteria in presumptive ECG diagnosis of LVH. MethodsThis is a retrospective electronic medical record study from September 1, 2017, to September 1, 2018, of 499 consecutive ECGs from Boca Raton Regional Hospital. Different ECG criteria were used to identify the presence of LVH, including the Cornell criteria, modified Cornell criteria, Sokolow-Lyon criteria, and Romhilt-Estes criteria. The main study outcome was to compare the R-E criteria in presumptive ECG diagnosis of LVH to the voltage-based criteria (Cornell, modified Cornell, and Sokolow-Lyon). ResultsAfter analyzing the ECGs using the different ECG criteria, R-E criteria were positive with LVH present (score ≥ 5 points) in 162 patients. In contrast, Cornell criteria were positive in 42 patients (8.4%), modified Cornell criteria in 50 patients (10%), and Sokolow-Lyon criteria in 13 patients (2.6%). In addition, R-E criteria showed higher positivity of LVH diagnosis compared to the sum of three voltage-based criteria (32.7% versus 21% respectively, p<0.001). ConclusionWe presume that R-E criteria can help better diagnose LVH by ECG compared to other commonly-used voltage-based criteria. However, further studies are needed using confirmatory imaging to confirm the accuracy of R-E criteria and compare it with other voltage based-criteria.

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“…In fact, the sensitivity of the R‐E ECG criteria for predicting increased LV mass has been estimated at only 60% (Romhilt & Estes, 1968 ). Previous studies have also reported that the R‐E ECG score predicts sudden cardiac arrest (SCA) independent of LV mass and ejection fraction (Darouian et al, 2017 ). As such, there appears to be an overlap between the association of DID with ECG LVH and anatomic LVH; however, DID appears to confer an arrhythmogenic risk independent of anatomic LVH as well.…”

Section: Left Ventricular Hypertrophymentioning

confidence: 99%

Delayed intrinsicoid deflection: Electrocardiographic harbinger of heart disease

Aiken

Goldhaber

Chugh

2022

Noninvasive Electrocardiol

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Delayed intrinsicoid deflection (DID) is an emerging electrocardiogram (ECG) marker of major clinical significance that is increasingly getting attention. Intrinsicoid deflection measures ventricular depolarization in the initial portion of the QRS complex, and DID is defined as an R wave peak time of ≥50 ms in leads V 5 and V 6 . Prior studies have identified an independent association between DID and cardiovascular conditions such as left ventricular hypertrophy, heart failure, and sudden cardiac death. The exact mechanism that results in DID remains unknown. Animal models indicate that DID may result from abnormal calcium and potassium conductance as well as extracellular matrix remodeling. DID remains an ECG marker of interest given its potential predictive value of underlying cardiovascular pathology and adverse events. This review provides an update on the proposed mechanisms and associations, as well as the clinical and research implications of DID.

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The Romhilt‐Estes electrocardiographic score predicts sudden cardiac arrest independent of left ventricular mass and ejection fraction

Cited by 10 publications

References 39 publications

ECG left ventricular hypertrophy as a risk predictor of sudden cardiac death

ECG left ventricular hypertrophy as a risk predictor of sudden cardiac death

The Use of Romhilt-Estes Criteria in the Presumptive Electrocardiographic Diagnosis of Left Ventricular Hypertrophy in Comparison to Voltage-Based Criteria

Delayed intrinsicoid deflection: Electrocardiographic harbinger of heart disease

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