V_1、V_2、V_3的S波及Ⅰ、Ⅱ、aVL的R波之和在诊断左室肥大中的价值

目的探讨诊断左室肥大(LVH)新的心电图指标。方法以超声心动图测定的左室重量(LVM)及重量指数(LVMI)为对照,其诊断LVH的标准为>125g/m2(男),120g/m2(女),对100例正常健康人及111例患者进行了观察,对12导联QRS总振幅(∑QRS)、V1～V3导联的S波之和(∑SV1～V3)、Ⅰ、Ⅱ、aVL导联的R波之和(∑RⅠ、Ⅱ、aVL)及后两者之和(Z表示),分别进行了测定。寻找新指标的正常值范围以及以此标准为依据,诊断LVH的灵敏度、特异度、准确率。结果正常组中,∑QRS、∑SV1～V3、∑RⅠ、Ⅱ、aVL及Z值正常范围分别为77～175,11～38,5～23及22～54mm,以大于这些指标的正常值上限为标准,其诊断LVH灵敏度、特异度及准确率较传统指标明显提高,其中Z值>54mm灵敏度最高(86.54%),准确率最高(90.09%),而特异度仍保持在93.22%。结论LVH新的心电图指标具有一定诊断价值,其中Z>54mm最好。     

S_(aVR)与R_(aVL)+S_(V_3)标准诊断左室肥大的价值

目的探讨SaVR与RaVL+SV3电压标准诊断左室肥大(LVH)的价值。方法以超声心动图结果为诊断标准,测量有LVH者100例(A组)及无LVH者100例(B组)的心电图(ECG)SaVR和RaVL+SV3电压。计算B组SaVR和RaVL+SV3电压的均数及标准差,获取诊断LVH的ECG新标准,并与传统标准比较,检验不同标准对诊断LVH的敏感度、特异度及准确度。结果①SaVR诊断LVH的灵敏度低(36%),特异度高(100%),准确度为68%;传统标准及RaVL+SV3诊断LVH的灵敏度提高(52%及58%),但特异度明显下降(70%及84%),准确度60%及71%。②两者联用诊断LVH的灵敏度及准确度提高,特异度无明显降低,分别为68%、76%、84%;③两者联用对诊断LVH伴电轴左偏者的灵敏度显著提高,为77.9%,准确度与特异度相近,分别为78.8%、82.3%;④两者联用在成人各年龄组中及不同体型中诊断LVH的价值无差异。结论SaVR及RaVL+SV3标准诊断LVH具有临床实用价值,两者联用则更为理想,可弥补单用的不足。     

Left ventricular hypertrophy: relationship of anatomic, echocardiographic and electrocardiographic findings

Anatomic, echocardiographic and ECG findings of left ventricular hypertrophy (LVH) were compared in 34 subjects. Echocardiographic LV mass correlated weel with postmortem LV weight (r = 0.96) and accurately diagnosed LVH (sensitivity 93%, specificity 95%). In contrast, Romhilt-Estes (RE) point score and Sokolow-Lyon (SL) voltage criteria for ECG LVH were insensitive (50% and 21%, respectively) but specific (both 95%). RE correlated weakly with LV weight (r = 0.64), but SL did not. Echocardiographic LV mass was then compared with RE and SL in an unselected clinical series of 100 subjects, in 28 subjects with severe aortic stenosis (AS) and in 14 with severe aortic regurgitation (AR). Results in the clinical series were comparable to those in the necropsy series. In the AS and AR groups, with a high prevalence of LVH, the low sensitivity of RE point score and Sl criteria led to poor overall results. Analysis of individual ECG variables showed that most voltage information is contained in leads aVL and V1. Correction of voltage for distance from the left ventricle did not substantially improve results. Individual nonvoltage criteria were each nearly as sensitive as RE point score. We could not devise new ECG criteria that improved diagnostic results. We conclude that the ECG is specific but insensitive in recognition of LVH. Moreover, when true LVH prevalence is less than 10%, more false-positive than true-positive diagnoses will be obtained. M-mode echocardiographic LV mass is superior to ECG criteria for clinical diagnosis of LVH.     

Improved cardiovascular risk stratification by a simple ECG index in hypertension

BACKGROUND: We determined the prognostic value of the Cornell/strain [C/S] index, a simple electrocardiographic (ECG) index for left ventricular hypertrophy (LVH) defined by the presence of either a classic strain pattern or a Cornell voltage (sum of R in aVL + S in V(3)) >2.0 mV in women or 2.4 mV in men, or both. METHODS: In a prospective, cohort study, 2190 initially untreated subjects (age 51 [+/- 12], 47% women) with essential hypertension without prior events were followed for up to 14 years (median, 5 years). RESULTS: Prevalence of LVH at entry was 16.3% by using the C/S index, which yielded 33.6% sensitivity and 91.0% specificity. Other ECG criteria for LVH including Sokolow-Lyon, Romhilt-Estes, Framingham, Cornell, and strain alone, achieved a lower sensitivity and prevalence. Over the subsequent follow-up, 244 patients experienced a first major cardiovascular event. Event rate (x 100 person-years) was 2.01 in those without and 4.44 in those with LVH by the C/S index (P <.001). After adjustment for age, sex, smoking, and other counfounders, the C/S index identified subjects at increased risk of events (relative risk 1.76; 95% confidence interval 1.32-2.33). The C/S index achieved the highest population-attributable risk (16.1%) for cardiovascular events. CONCLUSIONS: A simple ECG index that can be quickly measured from nondigital machines and without algorithms identifies LVH in a consistent proportion (16.3%) of hypertensive subjects. The LVH defined by such technique allows identification of individuals at high risk for cardiovascular events.     

New gender-specific partition values for ECG criteria of left ventricular hypertrophy: recalibration against cardiac MRI

ECG criteria for left ventricular hypertrophy (LVH) were mostly validated using left ventricular mass (LVM) as measured by M-mode echocardiography. LVM as measured by cardiac MRI has been demonstrated to be much more accurate and reproducible. We reevaluated the sensitivity and specificity of 4 ECG criteria of LVH against LVM as measured by cardiac MRI. Patients with systemic hypertension (n=288) and 60 normal volunteers had their LVM measured using a 1.5-Tesla MRI system. A 12-lead ECG was recorded, and 4 ECG criteria were evaluated: Sokolow-Lyon voltage, Cornell voltage, Cornell product, and Sokolow-Lyon product. Based on a cardiac MRI normal range, 39.9% of the hypertensive males and 36.7% of the hypertensive females had elevated LVM index. At a specificity of 95%, the Sokolow-Lyon product criterion had the highest sensitivity in females (26.2%), the Cornell criterion had the highest sensitivity in males (26.2%), and the Cornell product criteria had a relatively high sensitivity in both males and females (25.0% and 23.8%). Receiver operating characteristic curves showed the Cornell and Cornell product criteria to be superior for males whereas the Sokolow-Lyon product criterion was superior for females. Comparing the mean LVM index values of the subjects who were ECG LVH positive to the normal volunteers indicated that the ECG LVH criteria detect individuals with an LVM index substantially above the normal range. We have redefined the partition values for 4 different ECG LVH criteria, according to gender, and found that they detect subjects with markedly elevated LVM index.     

Electrocardiographic left ventricular hypertrophy has low diagnostic accuracy in middle-aged subjects

Objective. To evaluate the usefulness of electrocardiographic left ventricular hypertrophy (ECG LVH) as a marker of LVH in middle-aged subjects. Methods. LVH was determined by cardiovascular magnetic resonance imaging (MRI) in 188 apparently healthy middle-aged [97 men (45±7 years) and 91 women (47±6 years)]. Receiver operating characteristic (ROC) curves, test sensitivity, specificity, positive and negative predictive values for identifying LVH at different ECG criteria were calculated. Results. Systolic and diastolic blood pressures were 142±13 mmHg and 90±8 mmHg in men and 139±10 mmHg and 90±8 mmHg in women, respectively. LVMI was 78±17 g/m² in men and 67±12 g/m² in women, and 14% of men and 22% of women had LVH in cardiac MRI. Only Sokolow-Lyon and Sokolow-Lyon product had the area under the ROC curve over 0.70. Sokolow-Lyon product had the highest sensitivity (47%). All ECG criteria had high negative predictive values, but the positive predictive values were below 46%. Conclusions. Commonly used ECG criteria of LVH have low discrimination ability in middle-aged subjects. ECG LVH alone should not be used as a marker of target organ damage in middle-aged, never treated and apparently healthy hypertensives.     

Improved scoring system for the electrocardiographic diagnosis of left ventricular hypertrophy

BACKGROUND Left ventricular hypertrophy(LVH) is a common manifestation of cardiovascular disease and a risk factor for cardiovascular morbidity and mortality, but available methods for its electrocardiographic(ECG) diagnosis have limited accuracy.AIM To investigate findings associated with LVH on ECG and developed an improved system for the diagnosis of LVH.METHODS A cohort study comparing ECG data acquired within 30 days of transthoracic echocardiography(TTE) was performed. Multivariate regression analysis identified ECG findings associated with increased LV mass and mass index. A scoring system was derived and performance compared to established criteria for LVH.RESULTS Data from 5486 outpatients with TTEs and corresponding ECGs were included in the derivation cohort, 333(6.1%) of whom had LVH by TTE. In the primary regression analysis, findings associated with LVH were amplitudes of Q in V3, R in V6, S in V3, T in V6, P' in V1, P in V6, as well as R and T-axis discordance, R peak time in V6, QRS duration, weight, height, sex, and age. From this we derived a score consisting of 5 criteria, and validated it in an independent cohort of 910 patients. With a threshold of 1.5 points, sensitivity and specificity were67.9% and 81.4%, and 62.5% and 83.2% in the derivation and validation cohorts,respectively. With a threshold of 2 points, sensitivity and specificity were 42.3% and 93.0%, and 37.5% and 93.4% in these cohorts.CONCLUSIONS This score had superior sensitivity for detection of LVH by ECG while making a modest sacrifice in specificity compared to conventional criteria.     

Routine electrocardiographic criteria for the diagnosis of left ventricular hypertrophy: performance in Black Africans

OBJECTIVE: To determine, in Black Africans, the performance of routine electrocardiographic criteria in the diagnosis of left ventricular hypertrophy (LVH). METHODS: Thirty voluntary healthy subjects and 154 patients were explored at echocardiography (according to Pen convention) and 12-lead electrocardiography (ECG). The performance of Lewis, Sokolow and Cornell (Cornell S1 for a threshold of 28 mm in men, and Cornell S2, for a threshold of 24 mm) criteria were defined by their sensitivity, specificity, positive and negative predictive values. RESULTS: The prevalence of LVH in the 154 patients ranged from 15.6% to 35.7%, according to the ECG criteria. Sensitivities were of 0.19, 0.43, 0.30 and 0.76 for the Lewis, Sokolow, Cornell S1 respectively, and the specificities were of 0.89, 0.73, 0.91 and 0.54. Positive predictive value ranged from 0.16 (Cornell S2) to 0.91 (Cornell S2), and the negative predictive value, from 0.48 (Lewis) to 0.86 (Cornell S2). CONCLUSION: Routine ECG criteria for the diagnosis LVH have low performance in Black African. There is a need of new ECG criteria with better performance.     

Ethnic differences in electrocardiographic criteria for left ventricular hypertrophy: the LIFE study. Losartan Intervention For Endpoint

BACKGROUND: African Americans have greater precordial QRS voltages than whites, with concomitant higher prevalences of electrocardiographic (ECG) left ventricular hypertrophy (LVH) and lower specificity of ECG LVH criteria for the identification of anatomic hypertrophy. However, the high mortality associated with LVH in African American patients makes more accurate ECG detection of LVH in these patients a clinical priority. METHODS: Electrocardiograms and echocardiograms were obtained at study baseline in 120 African American and 751 white hypertensive patients enrolled in the Losartan Intervention For Endpoint (LIFE) echocardiographic substudy. The ECG LVH was determined using Sokolow-Lyon, 12-lead sum, and Cornell voltage criteria. Echocardiographic LVH was defined by LV mass indexed to height(2.7) >46.7 g/m(2.7) in women and >49.1 g/m(2.7) in men. RESULTS: After adjusting for ethnic differences in LV mass, body mass index, sex, and prevalence of diabetes, mean Sokolow-Lyon and 12-lead sum of voltage were significantly higher, but Cornell voltage was lower, in African Americans than in whites. As a consequence of these differences, when identical partition values were used in both ethnic groups, Sokolow-Lyon and 12-lead voltage criteria had lower specificity in African Americans than whites (44% v 69%, P = .007 and 44% v 59%, P = .10) but had greater sensitivity in African Americans (51% v 27%, P < .001 and 62% v 45%, P = .003). In contrast, Cornell voltage specificity was higher (78% v 62%, P = .09) but sensitivity was slightly lower (49% v 57%, P = 0.16) in African Americans. However, when overall test performance was compared using receiver operating curve analyses that were independent of partition value selection, ethnic differences in test performance disappeared, with no differences in accuracy of any of the ECG voltage criteria for the identification of LVH between African American and white hypertensive individuals. CONCLUSIONS: When standard, non-ethnicity-specific thresholds for the identification of LVH are used, Sokolow-Lyon and 12-lead voltage overestimate and Cornell voltage underestimates the presence and severity of LVH in African American relative to white individuals. However, these apparent ethnic differences in test performance disappear when ethnic differences in the distribution of ECG LVH criteria are taken into account. These findings demonstrate that ethnicity-specific ECG criteria can equalize detection of anatomic LVH in African American and white patients.     

Electrocardiographic patterns of patients with echocardiographically determined biventricular hypertrophy.

The numerous criteria proposed for the electrocardiographic (ECG) diagnosis of biventricular hypertrophy (BVH) suffer from inadequate correlative data. We used two-dimensional (2D) echocardiography to identify BVH and analyzed the ECG patterns in these patients. The study group had 69 such patients with BVH and the control group had 22 patients with isolated left ventricular hypertrophy (LVH) demonstrated by 2D echocardiography. The electrocardiograms were analyzed for the presence of established criteria used in the diagnosis of LVH and right ventricular hypertrophy (RVH). Of the 69 patients in the study group, 17 (25%) had ECG findings of BVH, 25 (36%) had LVH, and 14 (20%) had RVH. An S wave in V5/V6 of >7 mm was most the frequent finding in the 17 patients with BVH on the electrocardiogram. The sensitivity of ECG criteria for BVH was 24.6%, specificity was 86.4%, and positive predictive value was 85%. This study reemphasizes the difficulty of ECG diagnosis of BVH. The electrocardiogram has a low sensitivity but satisfactory specificity and positive predictive accuracy for BVH.     

Electrocardiographic assessment of left ventricular hypertrophy with time-voltage QRS and QRST-wave areas

The sum of time-voltage QRS areas in the 12-lead electrocardiogram (ECG) has outperformed other 12-lead ECG indices for detection of left ventricular hypertrophy (LVH). We assessed indices of time-voltage QRS and T-wave (QRST) areas from body surface potential mapping (BSPM) for detection of and quantitation of the degree of LVH. We studied 42 patients with echocardiographic LVH (LVH group) and 11 healthy controls (controls). QRST area sums were calculated from 123-lead BSPM and from the 12-lead ECG for comparison. Leadwise discriminant indices and correlation coefficients were used to identify optimal recording locations for QRST area-based LVH assessment. BSPM QRS area sum was greater in the LVH group than in controls (3752 +/- 1259 vs 2278 +/- 627 microV s, respectively; P<0.001) and at 91% specificity showed 74% sensitivity for LVH detection. The 12-lead QRS area sum performed similarly. Taking T-wave areas into account did not improve the results. QRS area sum from two most informative leads (located in the upper and lower right precordium) also separated the LVH group from controls (61.1 +/- 23.5 vs 27.8 +/- 6.5 microV s, respectively; P<0.00001). This 2-lead QRS area sum showed 90% sensitivity with 100% specificity for LVH detection and maintained high correlation to indexed left ventricular mass (r=0.732; P<0.001). In conclusion, the BSPM QRS area sum compared to 12-lead QRS area sum does not substantially improve LVH assessment. The 2-lead QRS area sum may improve ECG QRS area-based LVH assessment.     

Effect of sex on informative power of various electrocardiographical criteria of left ventricular hypertrophy in patients with excessive body mass

Aim of the study was to analyze dependence of various voltage parameters of QRS complex on increase of left ventricular myocardial mass (LVMM) in samples of men and women with excessive body mass or obesity. We included data from 223 patients with excessive body mass and diagnosis of stage I - II arterial hypertension. ECG was registered in 12 standard leads. Left ventricular hypertrophy (LVH) was certified if according to echoCG data LVMM exceeded 125 g/m2 in men and 110 g/m2 in women. Depending on sex and presence of LVH all patients were divided into 4 groups: M1 (men with LVH, n=74), M2 (men without LVH, n=74), W1 (women with LVH, n=55), anb W2 (women without LVH, n=20). We analyzed amplitudes of all waves of the QRS complex as well as Sokolow-Lyons voltage parameters and the Cornell index. The following intergroup differences were most significant: between groups M1 and M2 - in amplitudes of S waves in chest leads V3, V4; between groups W1 and W2 - in amplitudes of R-waves in limb leads I and aVL, and amplitudes of S-waves in lead III. Increases of the Cornell voltage index were observed both in men and women with LVH. The following criteria had greatest sensitivity at 95% specificity: in men - SV4 > 1,1 mV (34%) and RaVL+SV3 > 2,3 mV (32%); in women - RaVL > 0,8 mV (56%) and RI+SIII > 1,5 mV (56%). Informative power of electrocardiographical diagnosis of LVH can be augmented by the use of different voltage criteria in groups of men and women. In men most informative are chest leads (SV1 - V3, RaVL) while in women - limb leads (RI, RaVL, and SIII). The use of combination parameters RaVL+SV3 > 2,3 mV (in men) and RI+SIII > 1,5 mV (in women) allows to augment sensitivity with unchanged specificity. In patients with excessive body mass voltage the Sokolow-Lyons criterion is not informative. Most significant component of the Cornell voltage criterion in groups of men with excessive body mass is amplitude of SV3, in groups of women - amplitude of RaVL.     

The electrocardiogram is an unreliable method of identifying left ventricular hypertrophy in stable, treated angina patients

In coronary artery disease (CAD), a potentially reversible factor leading to cardiac death is left ventricular hypertrophy (LVH). While the electrocardiogram (ECG) is a widely available way to diagnose LVH, its sensitivity and specificity has never been assessed in this particular patient group where added ischaemic changes on ECG might complicate things. Furthermore, there are at least 11 different ECG criteria proposed to identify LVH. We sought to determine how many cases of echocardiography (echo) LVH would be missed if all of these different ECG criteria were applied in a group of stable, treated angina patients. A total of 241 consecutive patients with angiographically confirmed CAD were prospectively recruited and 11 ECG criteria were assessed on each subject and compared with the presence or absence of LVH on echo. Individual sensitivity, specificity, positive predictive value and negative predictive value were calculated for each ECG LVH criteria. The prevalence of echo LVH in the entire CAD population was 43%. All the proposed ECG criteria were poor at identifying echo LVH. The Cornell product yielded the highest rate of change value but still missed up to 80% of the echo LVH cases. We conclude that in a group of stable, treated angina patients, ECG is an unreliable method of identifying LVH. As LVH is very common in this patient population, screening by means of echo might be indicated. This will enable intensified efforts to ensure LVH regression, which is associated with reduction in both cardiovascular morbidity and mortality.     

Electrocardiographic diagnosis of left ventricular hypertrophy by the time-voltage integral of the QRS complex

Objectives. This study was conducted to test the hypothesis that the time-voltage integral of the QRS complex can improve the electrocardiographic (ECG) identification of left ventricular hypertrophy.Background. Standard ECG criteria have exhibited poor sensitivity for left ventricular hypertrophy at acceptable levels of specificity. However, left ventricular mass may be more closely related to the time-voltage integral of the summed left ventricular dipole than to QRS duration or voltages used in standard ECG criteria.Methods. Standard 12-lead ECGs, orthogonal lead signal-averaged ECGs and echocardiograms were obtained in 62 male control subjects without left ventricular hypertrophy and 51 men with left ventricular hypertrophy defined by echocardiographic criteria (indexed left ventricular mass >125 g/m²). Voltage of the QRS complex was integrated over the total QRS duration in leads X, Y and Z to calculate the time-voltage integral of each orthogonal lead, of the maximal spatial vector complex and of the horizontal, frontal and sagittal plane vector complexes.Results. At matched specificity of 99%, the 73% (37 of 51) sensitivity of the time-voltage integral of the vector QMS complex in the horizontal plane was significantly greater than the 10% sensitivity of the Romhilt-Estes point score, the 16% sensitivity of QRS duration alone, the 22% sensitivity of Cornell voltage, the 33% sensitivity of the 12-lead sum of QRS voltage and the 37% sensitivity of Sokolow-Lyon voltage (each p < 0.001). Sensitivity of the horizontal plane time-voltage integral was also greater than the 10% to 51% sensitivity of the time-voltage integral calculated in the individual X, Y or Z leads (p < 0.01 to < 0.001), the 18% and 35% sensitivity of the time-voltage integrals of the frontal and sagittal plane vectors (p < 0.001) and the 49% sensitivity of the time-voltage integral of the maximal spatial vector complex calculated from all three orthogonal leads (p < 0.001). Comparison of receiver operating characteristic curves confirmed that the superior performance of the horizontal plane time-voltage integral relative to standard and other signal-averaged criteria was independent of partition value selection.Conclusions. These findings suggest that use of the time-voltage integral of the QRS complex, a method that can be readily implemented on commercially available computerized ECG systems, can improve the accuracy of ECG methods for the identification of left ventricular hypertrophy.     

Correction of QRS voltage for body mass index does not improve the prediction of fatal and nonfatal cardiovascular events. The Moli-sani study

Background and aimsThe diagnosis of LVH by ECG may particularly difficult in obese individuals. The aim of this study was to prospectively investigate whether the correction for body mass index (BMI) might improve the prognostic significance for cerebro and cardiovascular events of two electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) in a large cohort of Italian adults.Methods and resultsIn 18,330 adults (54 ± 11 years, 55% women) from the Moli-sani cohort, obesity was defined using the ATPIII criteria. The Sokolow–Lyon (SL) and Cornell Voltage (CV) criteria were used for ECG–LVH. In overweight and obese subjects, as compared with normal weight, the prevalence of ECG–LVH by the SL index was lower. During follow-up (median 4.3 yrs), 503 cerebro and cardiovascular events occurred. One standard deviation (1-SD) increment in uncorrected and in BMI-corrected SL index and CV was associated with an increased risk of events (HR 1.12, 95% CI 1.02–1.22 and HR 1.16, 95% CI 1.06–1.26 and HR 1.12, 95% CI 1.03–1.23 and HR 1.17, 95% CI 1.07–1.27, respectively for SL and CV). In obese subjects, 1-SD increment in uncorrected CV and in BMI-corrected CV was not associated to a significant risk of events (HR 1.05, 95% CI 0.910–1.22 and HR 1.08, 95% CI 0.95–1.23 respectively). Uncorrected SL index showed a significant association with events, which was marginally stronger with BMI-corrected SL voltage (HR 1.18, 95% CI 1.02–1.37 and HR 1.17, 95% CI 1.04–1.33 respectively, Akaike information criterion change from 3220 to 3218).ConclusionsBMI correction of ECG LVH voltage criteria does not significantly improve the prediction of cerebro and cardiovascular events in obese patients in a large cohort at low cardiovascular risk.     

Regression of electrocardiographic left ventricular hypertrophy or strain is associated with lower incidence of cardiovascular morbidity and mortality in hypertensive patients independent of blood pressure reduction – A LIFE review

Cornell product criteria, Sokolow–Lyon voltage criteria and electrocardiographic (ECG) strain (secondary ST-T abnormalities) are markers for left ventricular hypertrophy (LVH) and adverse prognosis in population studies. However, the relationship of regression of ECG LVH and strain during antihypertensive therapy to cardiovascular (CV) risk was unclear before the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) study. We reviewed findings on ECG LVH regression and strain over time in 9193 hypertensive patients with ECG LVH at baseline enrolled in the LIFE study.The composite endpoint of CV death, nonfatal MI, or stroke occurred in 1096 patients during 4.8 ± 0.9 years follow-up. In Cox multivariable models adjusting for randomized treatment, known risk factors including in-treatment blood pressure, and for severity ECG LVH by Cornell product and Sokolow–Lyon voltage, baseline ECG strain was associated with a 33% higher risk of the LIFE composite endpoint (HR. 1.33, 95% CI [1.11–1.59]). Development of new ECG strain between baseline and year-1 was associated with a 2-fold increased risk of the composite endpoint (HR. 2.05, 95% CI [1.51–2.78]), whereas the risk associated with regression or persistence of ECG strain was attenuated and no longer statistically significant (both p > 0.05). After controlling for treatment with losartan or atenolol, for baseline Framingham risk score, Cornell product, and Sokolow–Lyon voltage, and for baseline and in-treatment systolic and diastolic blood pressure, 1 standard deviation (SD) lower in-treatment Cornell product was associated with a 14.5% decrease in the composite endpoint (HR. 0.86, 95% CI [0.82–0.90]). In a parallel analysis, 1 SD lower in-treatment Sokolow–Lyon voltage was associated with a 16.6% decrease in the composite endpoint (HR. 0.83, 95% CI [0.78–0.88]).The LIFE study shows that evaluation of both baseline and in-study ECG LVH defined by Cornell product criteria, Sokolow–Lyon voltage criteria or ECG strain improves prediction of CV events and that regression of ECG LVH during antihypertensive treatment is associated with better outcome, independent of blood pressure reduction.     

Electrocardiographic left ventricular hypertrophy and effects of antihypertensive drug therapy in hypertensive participants in the Multiple Risk Factor Intervention Trial

Data are reported on electrocardiographic left ventricular hypertrophy (ECG LVH) among 8,012 men classified as hypertensive at baseline in the Multiple Risk Factor Intervention Trial. Compared with those allocated to the usual care (UC) control group, men allocated to the special intervention (SI) group experienced a mean reduction of 4 mm Hg in diastolic blood pressure and 7 mm Hg in systolic blood pressure, over 6 years of follow-up. There were 378 new cases of ECG LVH during follow-up; the incidence in the SI group was about 23% less than that in the UC group (4.2 vs 5.4% 2P less than 0.01). Among the 189 men with ECG LVH at baseline, those in the SI group experienced about 24% more annual follow-up visits at which they were free of ECG LVH (4.6 vs 3.7 visits; 2P less than 0.01). This reduced incidence and increased reversal of ECG LVH in the SI group compared with that in the UC group was consistent with significant overall reductions (2P less than 0.001) among SI men in mean wave amplitude in those leads in which voltage is correlated with left ventricular mass (T wave in V1, R wave in aVL and S wave in V3). In SI and UC groups combined, the presence of ECG LVH either at baseline or at follow-up was associated with several-fold increases in death from cardiovascular diseases in general, and death from coronary artery disease in particular.(ABSTRACT TRUNCATED AT 250 WORDS)     

Electrocardiographic strain pattern and prediction of cardiovascular morbidity and mortality in hypertensive patients

The ECG strain pattern of lateral ST depression and T-wave inversion is a marker for left ventricular hypertrophy (LVH) and adverse prognosis in population studies. However, whether ECG strain is an independent predictor of cardiovascular (CV) morbidity and mortality in the setting of aggressive antihypertensive therapy is unclear. ECGs were examined at study baseline in 8854 hypertensive patients with ECG LVH who were treated in a blinded manner with atenolol- or losartan-based regimens. Strain was defined by the presence of a downsloping convex ST segment with an inverted asymmetrical T wave opposite to the QRS axis in leads V5 and/or V6 and was present in 971 patients (11.0%). The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study composite end point of CV death or nonfatal myocardial infarction or stroke occurred in 1035 patients (11.7%). In Cox analyses adjusting only for treatment effect, ECG strain was a significant predictor of CV death (hazard ratio [HR] 2.26, 95% confidence interval [CI] 1.78 to 2.86), fatal/nonfatal myocardial infarction (HR 2.16, 95% CI 1.67 to 2.80), fatal/nonfatal stroke (HR 1.76, 95% CI 1.39 to 2.21), and the composite CV end point (HR 1.99, 95% CI 1.70 to 2.33). After further adjusting for standard CV risk factors, baseline blood pressure, and severity of ECG LVH, ECG strain remained a significant predictor of CV mortality (HR 1.53, 95% CI 1.18 to 2.00), myocardial infarction (HR 1.55, 95% CI 1.16 to 2.06), and the composite CV end point (HR 1.33, 95% CI 1.11 to 1.59). Thus, ECG strain is a marker of increased CV risk in hypertensive patients in the setting of aggressive blood pressure lowering, independent of baseline severity of ECG LVH.     

Ethnic differences in left ventricular size and the prevalence of left ventricular hypertrophy among hypertensive patients vary with electrocardiographic criteria

The objective of this study was to investigate differences in electrocardiographic (ECG) parameters and the prevalence of left ventricular hypertrophy (LVH) by various ECG criteria between different ethnic groups in west Birmingham, United Kingdom. In all, 380 consecutive patients, mean age 63 (7.8) years, 75 (20%) female patients assessed for inclusion in hypertension trials in a city centre teaching hospital were studied: 303 (80%) were Caucasian, 43 (11.4%) Afro-Caribbean and 32 (8.5%) South Asian. LVH was assessed using seven different criteria, with adjustment for age and body mass index (BMI). The performance of the various criteria were compared between the three ethnic groups. There were significant differences in the R-wave voltage in lead aVL, the Sokolow-Lyon voltage and in criteria based on limb lead voltages alone between the three ethnic groups. Highest ECG voltages were seen in Afro-Caribbeans, and this translated into a significantly higher prevalence of LVH when assessed by the R-wave in aVL and the Sokolow-Lyon criteria. There were no significant differences between Caucasians and South Asians. These differences were abolished after adjustment for age and BMI. There was no difference in the Cornell voltage or its derivatives in men between the three ethnic groups. In conclusion, apparent differences in electrocardiographic voltage and the prevalence of LVH between ethnic groups are dependent upon the criteria chosen and may simply be secondary to differences in BMI. Unlike Afro-Caribbean patients, South Asians do not demonstrate significant differences in ECG voltage compared with Caucasians.     

The Diagnostic Value of 12‐Lead Electrocardiogram in Predicting Infarct‐Related Artery and Right Ventricular Involvement in Acute Inferior Myocardial Infarction

Background: The aim of the present study was to investigate the predictive value of presentation and 24‐hour electrocardiograms in defining the infarct‐related artery (IRA), its lesion segment, and the right ventricular involvement in acute inferior myocardial infarction (Ml). Methods: One hundred forty‐nine patients with acute inferior MI were included. Infarct‐related artery, its lesion segment, and the validity of new ECG criteria for the diagnosis of right ventricular Ml (RVMI) were investigated by means of criteria obtained from admission and 24‐hour ECGs. Results: The presence of ST‐segment elevation in lead III > lead II criterion (Criterion 1) and ST‐segment depression in lead I > lead aVL criterion (Criterion 2) from admission ECG defined the right coronary artery (RCA) as IRA with a sensitivity of 64% and a specificity of 100%. These two criteria also defined the proximal or mid lesions in RCA as culprit lesions (sensitivity of 99%, specificity of 96%). Absence of these two criteria indicated Cx as IRA with a sensitivity of 50% and a specificity of 97%. The depth of Q wave in lead III > lead II criterion (Criterion 3) had no value for discrimination of IRA, but the width of Q wave in lead III > lead II criterion (Criterion 4) supported the RCA to be IRA with a sensitivity of 60% and a specificity of 61% (Criteria 3 and 4 were obtained from 24‐hour ECGs). The finding of Criterion 1 plus Criterion 5 (ST elevation in V₁ but no ST elevation in V2) on admission ECG had a sensitivity of 63% and a specificity of 99% in the diagnosis of RVMI. Conclusion: We concluded that 12‐lead ECG is a cheap, easy, and readily obtainable diagnostic approach in discrimination of IRA and its culprit lesion segment. However, despite high specificity, due to moderate degree sensitivity, its value for the diagnosis of RVMI is questionable. A.N.E. 2001; 6(3):229–235