Hussein, M., Tareq, S., Al-juboori, O. (2023). The Accuracy of Electrocardiographic Criteria for Predicting Left Ventricular Hypertrophy in adult Patients with Systemic Hypertension. Alustath, 22(2), 156-165.
Muataz Fawzi Hussein; Saif Tareq; Omar Mohammed Hasan Al-juboori. "The Accuracy of Electrocardiographic Criteria for Predicting Left Ventricular Hypertrophy in adult Patients with Systemic Hypertension". Alustath, 22, 2, 2023, 156-165.
Hussein, M., Tareq, S., Al-juboori, O. (2023). 'The Accuracy of Electrocardiographic Criteria for Predicting Left Ventricular Hypertrophy in adult Patients with Systemic Hypertension', Alustath, 22(2), pp. 156-165.
Hussein, M., Tareq, S., Al-juboori, O. The Accuracy of Electrocardiographic Criteria for Predicting Left Ventricular Hypertrophy in adult Patients with Systemic Hypertension. Alustath, 2023; 22(2): 156-165.

The Accuracy of Electrocardiographic Criteria for Predicting Left Ventricular Hypertrophy in adult Patients with Systemic Hypertension

Iraqi Postgraduate Medical Journal
Volume 22, Issue 2, April 2023, Pages 156-165    PDF (238.83 K)
Document Type: Research Paper
Authors
Muataz Fawzi Hussein1; Saif Tareq2; Omar Mohammed Hasan Al-juboori2
1Department of Medicine/ College of Medicine / University of Baghdad, Baghdad, Iraq
2Baghdad Teaching Hospital , Baghdad, Iraq
Abstract
ABSTRACT:
BACKGROUND:
Left ventricular hypertrophy is a significant risk factor for cardiovascular complications such as ischemic heart disease, heart failure, sudden death, atrial fibrillation, and stroke. A proper non-expensive tool is required for detection of this pathology. Different electrocardiographic (ECG) criteria were investigated; however, the results were conflicting regarding the accuracy of these criteria.
OBJECTIVE:
To assess the accuracy of three electrocardiographic criteria in diagnosis of left ventricular hypertrophy in adult patients with hypertension using echocardiography as a reference test.
PATIENTS AND METHODS:
 This is a hospital-based cross sectional observational study which included 340 adult patients with                     a history of hypertension (240 patients with left ventricular hypertrophy and 100 patients without depending on Echocardiographic results). Three electrocardiographic criteria including Sokolow Lyon Voltage, Cornell voltage, and Cornell voltage duration were evaluated for their sensitivity and specificity in detection of left ventricular hypertrophy in those patients.
 RESULTS:
 Each of older ages (over 50 years) (OR= (OR=6.25, 95%CI=3.75-10.39, p<0.001), male gender (OR=0.58, 95% CI= 0.36-0.93, p= 0.018) and type 2 diabetes mellitus (OR=8.14, 95%CI= 4.04-16.41, p<0.001) were significantly associated with development of left ventricular hypertrophy in patients with hypertension. The sensitivity and specificity of Sokolow Lyon Voltage, Cornell voltage, and Cornell voltage duration were 17.5% and 96%; 13.33% and 97%; and 10% and 98%, respectively.
CONCLUSION:
 Older ages, male gender, and type 2 diabetes mellitus can increase the risk of left ventricular hypertrophy in hypertensive patients. All the studied criteria have low sensitivity and high specificity in recognition of the left ventricular hypertrophy in patients with hypertension, with no advantage of definite criterion over the others.
 
 
Keywords
Electrocardiographic (ECG) Criteria; Left ventricular hypertrophy (LVH); Hypertension
References
REFERENCES:

  1. Woroniecki RP, Kahnauth A, Panesar LE, et al. Left ventricular hypertrophy in pediatric hypertension: a mini review. Frontiers in Pediatr 2017;5:101.
  2. Lorell BH, Carabello BA. Left ventricular hypertrophy: pathogenesis, detection, and prognosis. Circulation 2000;102:470–79.
  3. Zabalgoitia M, Berning J, Koren MJ, et al; LIFE Study Investigators. Impact of coronary artery disease on left ventricular systolic function and geometry in hypertensive patients with left ventricular hypertrophy (the LIFE study). Am J Cardiol 2001;88:646–50.
  4. Flynn JT, Daniels SR, Hayman LL, et al. Update: ambulatory blood pressure monitoring in children and adolescents a scientific statement from the American Heart Association. Hypertens 2014; 63:1116–35.
  5. Liu T, Song D, Dong J, et al. Current understanding of the pathophysiology of myocardial fibrosis and its quantitative assessment in heart failure. Front Physiol 2017; 8: 238.
  6. Andersen S, Andersen A, Nielsen-Kudsk JE. The renin-agiotensin-aldosterone-system and right heart failure in congenital heart disease. Int J Cardiol Heart Vasc 2016; 11: 59-65.
 

  1. Mirvis DM, Goldberger AL. Electrocardiography. In: Zipes DP, Libby P, Bonow RG, et al. Braunward’s Heart Disease: A Textbook of Cardiovascular Medicine, 7th edition, Elsevier, Philadelphia, 2019: 117-151.
  2. Ogah OS, Oladapo OO, Adebiyi AA, et al. Electrocardiographic left ventricular hypertrophy with strain pattern: prevalence, mechanisms and prognostic implications. Cardiovasc J Afr. 2008; 19: 39‐
  3. Pewsner D, Juni P, Egger M, et al. Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review. BMJ. 2007; 335:711.
  4. Hancock EW, Deal B, Mirvis DM, et al. Recommendations for the standardization and interpretation of the electrocardiogram. Part V. ECG changes associated with cardiac chamber hypertrophy. J Am Coll Cardiol. 2009;53:982.
  5. Whitman IR, Patel VV, Soliman EZ, et al. Validity of surface electrocardiogram criteria for right ventricular hypertrophy. J Am Coll Cardiol. 2014;63:672.
  6. Armstrong A, Gidding S, Gjesdal J, et al. LVM assessed by echocardiography and cardiac magnetic resonance, cardiovascular outcomes, and medical practice. JACC Cardiovasc Imaging 2012; 5: 837–48.
  7. Stabouli S, Kotsis V, Rizos Z, et al. Left ventricular mass in normotensive, prehypertensive and hypertensive children and adolescents. Pediatr Nephrol 2009; 24:1545–51.
  8. Havranek EP, Emsermann CD, Froshaug DN. Threshold in the relationship between mortality and left ventricular hypertrophy defined by electrocardiography. J Electrocardiol 2008; 41: 342-50.
  9. Foster BJ, Khoury PR, Kimball TR, et al. New reference centiles for left ventricular mass relative to lean body mass in children. J Am Soc Echocardiogr 2016; 29: 441–47.
  10. Chuang ML, Beaudin RA, Riley MF, et al. Three-dimensional echocardiographic measurement of left ventricular mass: comparison with magnetic resonance imaging and two-dimensional echocardiographic determinations in man. Int J Card Imaging 2000; 16: 347–57.
 

 

 

  1. Sahn DJ, DeMaria A, Kisslo J, et al. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978; 58:1072–83.
  2. Picard MH, Adams D, Biering M,et al. American Society of Echocardiography recommendation for quality echocardiography laboratory operation Am Soci Echocardiography 2011:24:1-10.
  3. ESH/ESC Guidelines for the Management of Arterial Hypertension. Task force for the management of arterial hypertension of the European Society of Hypertension; task force for the management of arterial hypertension of the European Society of Cardiology, Blood Press. 2013;22:193–278.
  4. Lazano JV, Redon J, Cea-Calvo et al. Left ventricular hypertrophy in the Spanish hypertensive population. The ERIC-HTA study. Rev Esp Cardiol 2006;59:136-42.
  5. Gredts E, Roman Mj, Palmieri V, et al. Impact of age on left ventricular hypertrophy regression during antihypertensive treatment with losartan or atenolol (the LIFE study). J Hum Hypertens 2004; 18:417-22.
  6. Bella JN, Palmieri V, Wachtell K, et al. Sex-related difference in regression of left ventricular hypertrophy with a regression during antihypertensive treatment with losartan or atenolol (the LIFE study). J Hum Hypertens 2004;18:411-16.
  7. Gredts E, Izzo R, Mancusi C, et al. Left ventricular hypertrophy offsets the sex difference in cardiovascular risk (the Campania Salute Network). Int J Cardiol 2018; 258: 257-61.
  8. Ruebner RL, Ng D, Mitsnefes M, et al. Cardiovascular disease risk factors and left ventricular hypertrophy in girls and boys with CKD. Clin J Am Soc Nephrol. 2016;11:1962-68.
  9. Gerdts E, Okin PM, de Simone G, et al. Gender differences in left ventricular structure and function during antihypertensive treatment. The Losartan Intervention for Endpoint reduction in hypertension study. Hypertension 2008; 51:1109–14.
164
  • de Simone G, Devereux RB, Chinali M. et al. Sex differences in obesity-related changes in left ventricular morphology: the Strong Heart Study. J Hypertens 2011; 29:1431–38.
 

  1. Villari B, Campbell SE, Schneider J, et al. Sex-dependent differences in left ventricular function and structure in chronic pressure overload. Eur Heart J 1995;16:1410–19
  2. Scantlebury DC, Borlaug BA. Why are women more likely than men to develop heart failure with preserved ejection fraction? Curr Opin Cardiol 2011; 26:562–68.
  3. Eguchi K, Boden-Albala B, Jin Z, et al. Association between diabetes mellitus and left ventricular hypertrophy in a multiethnic population. Am J Cardiol. 2008;101:1787-91.
  4. Eguchi K, Kario K, Hoshide S, Ishikawa J, Morinari M, Shimada K. Type 2 diabetes is associated with left ventricular concentric remodeling in hypertensive patients. Am J Hypertens. 2005;18:23-29.
  5. Palmieri V, Bella JN, Arnett DK, et al. Effect of type 2 diabetes mellitus on left ventricular geometry and systolic function in hypertensive subjects : Hypertension Genetic Epidemiology Network (HyperGEN) study. Circulation 2001;103:102–107.
  6. Devereux RB, Roman MJ, Paranicas M, et al. Impact of diabetes on cardiac structure and function: the Strong Heart Study. Circulation 2000;101:2271–76.
  7. Palmieri V, Tracy RP, Roman MJ, et al. Relation of left ventricular hypertrophy to inflammation and albuminuria in adults with type 2 diabetes: the Strong Heart Study. Diabetes Care 2003;26:2764–69.
  8. Burgos PF, Filho BL, Costa FD, et al. Electrocardiogram performance in the diagnosis of left ventricular hypertrophy in hypertensive patients with left bundle branch block. Arq Bras Cardiol 2017;108:47-52.
  9. Ogunlade O, Akintomode AO. Assessment of voltage criteria for left ventricular hypertrophy in adult hypertensive in South-Nigeria. J Cardiovasc Dis Res 2013;4:44-46.
  10. Elffers TW, Trompet S, de Mutsert R, et al. Electrocardiographic Detection of Left Ventricular Hypertrophy; Adding Body Mass Index and Spatial QRS-T Angle: A Cross-Sectional Study. Cardiol Ther. 2019;8:345-56.
  11. Pewsner D, Juni P, Egger M, et al. Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review. BMJ 2007;335:711.
 

 

  1. Casale PN, Devereux RB, Kligfield P, et al. Electrocardiographic detection of left ventricular hypertrophy: development and prospective validation of improved criteria. J Am Coll Cardiol 1985; 6: 572-80.
  2. Buchner S, Debl K, Haimerl J, et al. Electrocardiographic diagnosis of left ventricular hypertrophy in aortic valve disease: evaluation of ECG criteria by cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2009;11:18.
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