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An analysis of electrocardiographic criteria for determining left ventricular hypertrophy
Gasperin, Carlos Alberto;Germiniani, Helio;Facin, Carlos Roberto;Souza, Admar Moraes de;Cunha, Cláudio Leinig Pereira da;
Arquivos Brasileiros de Cardiologia , 2002, DOI: 10.1590/S0066-782X2002000100006
Abstract: objective: to determine the most sensitive criterion for the detection of left ventricular hypertrophy according to echocardiographically defined left ventricular mass. methods: the sokolow-lyon voltage, sokolow-lyon-rappaport, cornell voltage duration product, white-bock, and romhilt-estes point scoring criteria were compared with left ventricular mass index, corrected for body surface, obtained from the echocardiograms of 306 outpatients (176 females, 130 males), of all age groups. results: the cornell voltage duration product criteria index had the greatest sensitivity in women (54.90%), and the sokolow-lyon-rappaport index was most sensitive in men (73.53%). when applied to men at the same voltage amplitude (20mm) as that in women, the cornell index showed increased sensitivity relative to the conventional index (28mm) of 67.65% (p£0.01) and a sensitivity similar to that of the sokolow-lyon-rappaport index, with higher specificity (p£0.01). the white-bock and romhilt-estes criteria were the least sensitive in men and women, despite their high specificity. the electrocardiographic criteria were more efficient when dilatation predominated over left ventricular hypertrophy. conclusion: the cornell index had greater sensitivity in women, and the sokolow-lyon-rappaport index was more sensitive in men. when applied to men at the same voltage amplitude as that of women, the cornell index had an increase in sensitivity similar to that of the sokolow-lyon-rappaport index.
An analysis of electrocardiographic criteria for determining left ventricular hypertrophy  [cached]
Gasperin Carlos Alberto,Germiniani Helio,Facin Carlos Roberto,Souza Admar Moraes de
Arquivos Brasileiros de Cardiologia , 2002,
Abstract: OBJECTIVE: To determine the most sensitive criterion for the detection of left ventricular hypertrophy according to echocardiographically defined left ventricular mass. METHODS: The Sokolow-Lyon voltage, Sokolow-Lyon-Rappaport, Cornell voltage duration product, White-Bock, and Romhilt-Estes point scoring criteria were compared with left ventricular mass index, corrected for body surface, obtained from the echocardiograms of 306 outpatients (176 females, 130 males), of all age groups. RESULTS: The Cornell voltage duration product criteria index had the greatest sensitivity in women (54.90%), and the Sokolow-Lyon-Rappaport index was most sensitive in men (73.53%). When applied to men at the same voltage amplitude (20mm) as that in women, the Cornell index showed increased sensitivity relative to the conventional index (28mm) of 67.65% (P<=0.01) and a sensitivity similar to that of the Sokolow-Lyon-Rappaport index, with higher specificity (P<=0.01). The White-Bock and Romhilt-Estes criteria were the least sensitive in men and women, despite their high specificity. The electrocardiographic criteria were more efficient when dilatation predominated over left ventricular hypertrophy. CONCLUSION: The Cornell index had greater sensitivity in women, and the Sokolow-Lyon-Rappaport index was more sensitive in men. When applied to men at the same voltage amplitude as that of women, the Cornell index had an increase in sensitivity similar to that of the Sokolow-Lyon-Rappaport index.
Comparison of Araoye's criteria with standard electrocardiographic criteria for diagnosis of left ventricular hypertrophy in Nigerian hypertensives
A Dada, A A Adebiyi, A Aje, O O Oladapo, A O Falase
West African Journal of Medicine , 2006,
Abstract: Background: Left ventricular hypertrophy (LVH) is a major risk factor for cardiovascular morbidity and mortality. Various electrocardiographic (ECG) criteria for LHV give poorer performance in black subjects when compared with white subjects. Araoye proposed a code system for improved ECG diagnosis of LVH in blacks. The Araoye's criteria are yet to be validated in black subjects. Study design: Electrocardiograms and echocardiograms were obtained from 100 hypertensive subjects and 60 controls. ECG LVH was determined by the Araoye's code criteria, Sokolow-Lyon; Cornell voltage; and Romhilt-Estes point score. Echocardiographic LVH was defined by LV mass indexed for height at 97.5 percentile of the controls (126g.m-1 and 130g.m-1 in females and males respectively). Results: The prevalence of echocardiographic LVH indexed for height was 34% and 1.67% in the hypertensive and controls respectively while the prevalence of electrocardiographic LVH among the hypertensives were 18% by Romhilt Estes score, 48% by Sokolow-Lyon's criteria, 22% by Cornell's criteria and 51% by Araoye's criteria. The sensitivity and specificity respectively of the various electrocardiographic criteria were 65.7% and 76.8% for Sokolow-Lyon, 25.7% and 88.8% for Cornell's criteria 25.7% and 92.8% for Romhilt-Estes score and 71.4% and 74.4% for Araoye's criteria. Araoye's criteria did not differ significantly from Sokolow-Lyon criteria in identifying LVH but differed significantly from Cornell and Romhilt-Estes criteria. The number of positive codes in Araoye's criteria was significantly associated with the blood pressures, LV dimensions, and LV mass. Conclusion: The Araoye's code system for electrocardiographic diagnosis of LVH offer no comparative advantage over Sokolow-Lyon's criteria. However, the number of positive codes in Araoye's criteria identifies those individuals with more severe LVH. Introduction: Hypertrophie ventriculaire du gauche (HVG) est un facteur du risque majeur pour la morbidite et mortalité cardiovasculaire. Des critères électrocardiographique (BCG) divers pour HVG donne une execution mauvaise chez les sujets noirs par rapport aux sujets blancs. Araoye a proposé un système de code pour une amélioration diagnostique de ECG en ce qui concerne HVG chez des noirs. Le critère d' Araoye n'est pas encore confirmé chez des sujets noirs. Plan d'étude: Electrocardiograms et échocardiograms ont été obtenus chez 100 sujets hypertensifs et 60 groupe de témoin. ECG HVG était décidé par le critère du code d'Araoye, Sokolow-Lyon; Cornell Voltage; et romhilt- Estcs point du score. L'Echocardiographie HVG était défini par GV de masse indexé pour hauteur en 97,5 centile des contr le (126g.m-1 et 130g.m-1 chez des sexes féminin et masculin respectivement. Résultats: La fréquence d'HVG échocardiographique indexe pour I'hauteur était 34% et 1,67% chez les hypertensifs et Ie groupe de témoin respectivement. Tandis que la fréquence de HVG électrocardiographique parmi les hypertensif
Electrocardiographic Left Ventricular Hypertrophy and Outcome in Hemodialysis Patients  [PDF]
Seung Jun Kim, Hyung Jung Oh, Dong Eun Yoo, Dong Ho Shin, Mi Jung Lee, Hyoung Rae Kim, Jung Tak Park, Seung Hyeok Han, Tae-Hyun Yoo, Kyu Hun Choi, Shin-Wook Kang
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0035534
Abstract: Background and Aims Electrocardiography (ECG) is the most widely used initial screening test for the assessment of left ventricular hypertrophy (LVH), an independent predictor of cardiovascular mortality in patients with end-stage renal disease (ESRD). However, traditional ECG criteria based only on voltage to detect LVH have limited clinical utility for the detection of LVH because of their poor sensitivity. Methods This prospective observational study was undertaken to compare the prognostic significance of commonly used ECG criteria for LVH, namely Sokolow-Lyon voltage (SV) or voltage-duration product (SP) and Cornell voltage (CV) or voltage-duration product (CP) criteria, and to investigate the association between echocardiographic LV mass index (LVMI) and ECG-LVH criteria in ESRD patients, who consecutively started maintenance hemodialysis (HD) between January 2006 and December 2008. Results A total of 317 patients, who underwent both ECG and echocardiography, were included. Compared to SV and CV criteria, SP and CP criteria, respectively, correlated more closely with LVMI. In addition, CP criteria provided the highest positive predictive value for echocardiographic LVH. The 5-year cardiovascular survival rates were significantly lower in patients with ECG-LVH by each criterion. In multivariate analyses, echocardiographic LVH [adjusted hazard ratio (HR): 11.71; 95% confidence interval (CI): 1.57–87.18; P = 0.016] and ECG-LVH by SP (HR: 3.43; 95% CI: 1.32–8.92; P = 0.011) and CP (HR: 3.07; 95% CI: 1.16–8.11; P = 0.024) criteria, but not SV and CV criteria, were significantly associated with cardiovascular mortality. Conclusions The product of QRS voltage and duration is helpful in identifying the presence of LVH and predicting cardiovascular mortality in incident HD patients.
Electrocardiographic diagnosis of left ventricular hypertrophy in aortic valve disease: evaluation of ECG criteria by cardiovascular magnetic resonance
Stefan Buchner, Kurt Debl, Josef Haimerl, Behrus Djavidani, Florian Poschenrieder, Stefan Feuerbach, Guenter AJ Riegger, Andreas Luchner
Journal of Cardiovascular Magnetic Resonance , 2009, DOI: 10.1186/1532-429x-11-18
Abstract: 120 patients with aortic valve disease and 30 healthy volunteers were analysed. As ECG criteria for LVH, we assessed the Sokolow-Lyon voltage/product, Gubner-Ungerleider voltage, Cornell voltage/product, Perugia-score and Romhilt-Estes score.All ECG criteria demonstrated a significant correlation with LV mass and chamber size. The highest predictive values were achieved by the Romhilt-Estes score 4 points with a sensitivity of 86% and specificity of 81%. There was no difference in all ECG criteria between concentric and eccentric LVH. However, the intrinsicoid deflection (V6 37 ± 1.0 ms vs. 43 ± 1.6 ms, p < 0.05) was shorter in concentric LVH than in eccentric LVH and amplitudes of ST-segment (V5 -0.06 ± 0.01 vs. -0.02 ± 0.01) and T-wave (V5 -0.03 ± 0.04 vs. 0.18 ± 0.05) in the anterolateral leads (p < 0.05) were deeper.By calibration with CMR, a wide range of predictive values was found for the various ECG criteria for LVH with the most favourable results for the Romhilt-Estes score. As electrocardiographic correlate for concentric LVH as compared with eccentric LVH, a shorter intrinsicoid deflection and a significant ST-segment and T-wave depression in the anterolateral leads was noted.Left ventricular hypertrophy (LVH) is a hallmark of chronic pressure or volume overload of the left ventricle and is associated with a markedly elevated risk of cardiovascular morbidity and mortality. Morphologically, LVH may be characterized by increased wall thickness (concentric LVH), increased chamber volume (eccentric LVH) or both [1,2]. In order to identify LVH, the ECG is widely used as a primary screening tool. Various ECG criteria have been put forward, but there is little information as to the predictive values of the respective criteria for the correct diagnosis. Most importantly, the clinical utility of ECG has been limited by a low sensitivity at quite high specificity. Further, there is limited understanding of the contribution and importance of left ventricular volume
Determinants and Improvement of Electrocardiographic Diagnosis of Left Ventricular Hypertrophy in a Black African Population  [PDF]
Ahmadou M. Jingi, Jean Jacques N. Noubiap, Philippe Kamdem, Samuel Kingue
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0096783
Abstract: Background Left ventricular hypertrophy (LVH) is a major cardiovascular risk factor. The electrocardiogram (ECG) has been shown to be a poor tool in detecting LVH due to cardiac and extracardiac factors. We studied the determinants and possibility of improving the test performance of the ECG in a group of Black Africans. Methods We studied echocardiograms and electrocardiograms of 182 Cameroonian patients among whom 113 (62.1%) were having an echocardiographic LVH. Echocardiographic LVH was defined as Left Ventricular Mass Indexed to height 2.7(LVMI)>48 g/m2.7 in men, and >44 g/m 2.7 in women or Body Surface Area ≥116 g/m2 in men, and ≥96 g/m2 in women. Test performances were calculated for 6 classic ECG criteria Sokolow-Lyon, Cornell, Cornell product, Gubner-Ungerleiger, amplitudes of R in aVL, V5 and V6. Results The most sensitive criteria were Cornell (37.2%) and Sokolow-Lyon index (26.5%). The most specific criteria were Gubner (98.6%), RaVL (97.1%), RV5/V6 (95.7%) and Cornell product (94.2%). The performance of the ECG in diagnosing LVH significantly increased with the severity of LVH for Cornell index (r = 0.420, p<0.0001) and Sokolow index (r = 0.212, p = 0.002). It decreased with body habitus (r = ?0.248, p = 0.001) for Sokolow-Lyon index. Cornell index was less affected (age p = 0.766; body habitus: p = 0.209). After sex-specific adjustment for BMI, Cornell BMI sensitivity increased from 37.2% to 69% (r = 0.472, p<0.0001), and Sokolow-Lyon BMI sensitivity increased from 26.5% to 58.4% (r = 0.270, p<0.001). Conclusion The test performance of the ECG in diagnosing LVH is low in this Black African population, due to extracardiac factors such as age, sex, body habitus, and cardiac factors such as LVH severity and geometry. However, this performance is improved after adjustment for extracardiac factors.
Correlation Between Upper Airways Obstructive Indexes in Adenotonsilar Hypertrophy with Mean Pulmonary Arterial Pressure
Ehsan Khadivi,Mohsen Horri,Monavar Afzal Aghaee,bolfazl Taheri
Iranian Journal of Otorhinolaryngology , 2010,
Abstract: Introduction: Hypertrophied tonsils and adenoids may cause upper airway obstruction and cardio-pulmonary complications due to pulmonary arterial hypertension. The aim of this study was to determine the correlation between mean pulmonary arterial pressure (mPAP) and selected adenotonsilar hypertrophy indexes. Materials and Methods: Thirty two patients with upper-airway obstruction resulting from hypertrophied tonsils and adenoids were included in our study. Mean pulmonary arterial pressure was measured by a non-invasive method using color doppler echocardiography. Upper airway obstruction was evaluated by clinical OSA (obstructive sleep apnea) scoring and also adenoidal-nasopharyngeal (A/N) ratio in the lateral neck radiography. Results: Fifty percent of the patients with a normal OSA score, 20% of those with a suspected OSA score and also 50% of cases with OSA had pulmonary hypertension (mPAP>20mmHg) which was not statistically significant (P=0.198). Mean Adenoidal-nasopharyngeal ratio in patients with a normal mPAP (mPAP≤20mmHg) was 0.61±0.048 and it was 0.75±0.09 in those with pulmonary hypertension; the difference was statistically significant (P=0.016). Conclusion: It seems that A/N ratio could be used as a predicting factor for increased mPAP in children with upper airway obstruction and a pediatric cardiologist consultation may be necessary before some surgical interventions.
Resting electrocardiographic and echocardiographic findings in an urban community in the Gambia
BC Nkum, O Nyan, T Corrah, TC Ankrah, S Allen, FB Micah, K McAdam
Journal of Science and Technology (Ghana) , 2009,
Abstract: The presence of Left Ventricular Hypertrophy (LVH) in a patient with systemic hypertension deserves serious attention and makes its clinical diagnosis a priority. Over the years various criteria have been proposed for the electrographic (ECG) diagnosis of LVH and the sensitivity and specificity of these criteria have been extensively studied in Caucasians. Recent evidence indicates that they are inapplicable to people of African descent. Unlike echocardiography (ECHO), the ECG is generally available, cheap but has a lower sensitivity in detecting LVH compared to echocardiography. This study was conducted to evaluate ECG criteria against 2-dimensional (2-D) guided M-mode echocardiography in the diagnosis of LVH in adult Gambians. Secondly, to determine the ECG criteria using the Minnesota, Araoye, Sokolow and Lyon or Wolff criteria with the overall best accuracy for the diagnosis of LVH. Two hundred and eight (208) consecutive patients with systemic hypertension (BP .140/90mmHg) with or without treatment and an age matched group of 108 non-hypertensive patients were enrolled from outpatient clinics. A questionnaire was filled. All patients were investigated with 2-D guided M-mode echocardiography and a standard 12-1ead ECG. Anthropometric measurements were also taken. The gold standard was the Penn formula to determine the left ventricular mass index (of 125 g/m2 in males and 110 g/m2 in females as the cut-off for LVH). Using this gold standard the prevalence of echocardiographic LVH was 47.5% and 27.8 % in the hypertensives and non-hypertensives respectively (P<0.01). By the Receiver Operating Characteristic (ROC) Curves Sokolow and Lyon was nearest to the top left-hand corner in the hypertensives with a distance of 6.6cm. But in the non-hypertensives Wolff was nearest to the top left-hand corner with a distance of 8.5 cm. There was correlation between the Minnesota, Araoye, Sokolow and Lyon and Wolff ECG criteria and echocardiographic left ventricular mass index in the hypertensives (Spearman rho = 0.25 -0.34, P < 0.01) but in the non-hypertensives there was no correlation (P > 0.05). Sokolow and Lyon criterion had overall best accuracy for the electrocardiographic diagnosis of left ventricular hypertrophy in hypertensives and is further recommended for use as such. But for non-hypertensives, the Wolff criterion had overall best accuracy.
HYPERTENSIVE LEFT VENTRICULAR HYPERTROPHY
Mahboob Ahmad Wagan
The Professional Medical Journal , 2001,
Abstract: The left ventricular hypertrophy is sequlae of systemic hypertension. LVH leads to increasedarrhythmias, accelerated coronary atherosclerosis, and heart failure. The Framingham Heart Studyhas shown that LVH is powerful independent risk factor for cardiovascular morbidity andmortality. Therefore, the optimal anti-hypertensive therapy should provide the regression of LVH.Captropril causes regression of left ventricular hypertrophy. The study was done to calculate the thicknessof inter-ventricular septum, posterior wall and left ventricular internal diameter. M-mode echo-cardiographywas used in 20 patients of left ventricular hypertrophy. Captopril was given in the range of 25-150mg perday in patients of left ventricular hypertrophy with hypertension for a period of six weeks. Result on echocardiographyshows regression of IVST 12.45±0.15 to 11±0.24 and LVID (mm) 46.45±1.29 to 46.20±1.25.
Electrocardiographic abnormalities among dialysis na ve chronic kidney disease patients in Ilorin Nigeria
A Chijioke, AM Makusidi, PM Kolo
Annals of African Medicine , 2012,
Abstract: Background: Chronic kidney disease (CKD) has an increased risk of not only end-stage renal disease (ESRD), but majority of moderate CKD patients do die from cardiovascular disease (CVD) before reaching ESRD. The prognosis of these patients is very poor in most developing countries because of late presentation, inadequate diagnostic facilities, and inability to pay for treatment. Knowledge about CVD in CKD is crucial because of unpredictable progressive nature of the disease and increased risk of premature death from cardiovascular events. We sought to determine prevalence and pattern of electrocardiographic abnormalities in dialysis na ve CKD patients. Materials and Methods: This is a 10-year prospective cross-sectional study carried out at the University of Ilorin Teaching Hospital, Ilorin. Patients were recruited from the nephrology clinic and renal wards and all who met diagnostic criteria for stages 4 and 5 CKD were included. All had their standard 12–lead electrocardiogram (ECG) recorded and various findings were critically studied and interpreted independently by two consultant physician including a cardiologist. Data analysis was done using SPSS version 16. Results: Overall, 86% of the patients had at least one form of ECG abnormality, with hypertension (HTN) and anemia being the main contributory factors. These include left ventricular hypertrophy (LVH) (27.6%), left atrial enlargement (LAE) (21.6%), combination of LVH and LAE (17.2%), and ventricular premature contractions (6%). Etiology of CKD appears to have influence on ECG changes as prevalence of LVH and LAE were high among hypertensive renal disease, chronic glomerulonephritis (CGN), and diabetic nephropathy patients. Conclusion: LVH and LAE were very common ECG abnormalities in our dialysis na ve CKD patients. HTN, CGN, anemia, late presentation, and male gender appear to be the main risk factors for the ECG abnormalities. There is need for gender-specific intervention strategies directed at early detection and treatment of HTN, anemia, and underlying kidney disease, especially in resource poor nations where the burden of CKD is assuming epidemic proportion.
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