Supervisors info:
Δημήτριος Τούσουλης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ελένη Κυρίτση, Καθηγήτρια, Νοσηλευτική, ΕΚΠΑ
Κωνσταντίνος Τούτουζας, Καθηγητής, Ιατρική, ΕΚΠΑ
Summary:
Introduction: Left ventricular hypertrophy (LVH) is the cardiac adaptive form to pressure overload (eg hypertension), volume overload (eg mitral regurgitation) and natural conditions (eg anaemia, pregnancy). The ecg provides a strong suspicion of lvh, therefore the echocardiograph provided the final diagnose and the magnetic resonance of myocardium is the gold standard. The discrimination of forms, eccentric or concentric with ecg criteria is a powerful clinical tool since the approach of therapy and the prevention of cardiovascular death depends on the form of lvh.
Aim: The aim of this study was to determine the sensitivity and the specificity of seven classic criteria of ECG detection of LVH and especially concerning their performance in differentiating concentric and eccentric LVH.
Methods: In the setting of the Corinthia cross-sectional study, ECGs were analyzed in 1570 participants of the study. Seven ECG criteria were calculated (Sokolow–Lyon voltage, index and product, sex-specific Cornell voltage and product, Lewis voltage, and Framingham), whereas LVH was defined, based on echocardiographic data, as left ventricular mass indexed for body surface area (BSA) at least 125 g/m2 in men and at least 110 g/m2 in women.
Results: Regarding the frequency encountered of each ECG-LVH criterion, there was no difference between eLVH and cLVH. However, when ECG criteria as continuous variables were compared between LVH groups, Cornell voltage and product were higher in cLVH individuals, with a value of Cornell voltage > 13.95 mV having 61% sensitivity and 62% specificity to differentiate cLVH from eLVH (p=0.05). Even after adjustment for age, sex, body mass index and hypertension the occurrence of Cornell voltage or product increased the odds of cLVH by 1.6 times (p=0.001) while the incidence of Framingham criterion increased the odds of eLVH by 8 times (p=0.04).
Conclusion: Cornell voltage and product criteria have superior discriminative ability for the detection of LVH via ECG. When further categorizing 73
LVH as concentric and eccentric, Cornell product has the higher discriminative ability for cLVH and Framingham for eLVH.
Keywords:
LVH, Concentric, Eccentric, Ecg, Echo
