Electrocardiographic Detection of Left Ventricular Hypertrophy; Adding Body Mass Index and Spatial QRS-T Angle: A Cross-Sectional Study

Cardiology and Therapy - Tập 8 - Trang 345-356 - 2019
Theodora W. Elffers1,2, Stella Trompet1,3, Renée de Mutsert2, Arie C. Maan1, Hildo J. Lamb4, Peter W. Macfarlane5, Frits R. Rosendaal2, J. Wouter Jukema1
1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
2Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
3Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
4Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
5Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK

Tóm tắt

We investigated improvement of electrocardiographic LVH detection by adding measures of adiposity and/or novel electrocardiographic measures. Left ventricular hypertrophy (LVH) is an important risk factor for adverse cardiovascular outcomes. Improvement of electrocardiographic criteria for LVH is desirable, since electrocardiography is widely used. We included 1091 participants of the Netherlands Epidemiology of Obesity Study (NEO) who underwent cardiac magnetic resonance imaging (MRI). Performance of Sokolow–Lyon and Cornell voltage and product criteria was assessed. Stepwise regression analysis was performed with each conventional electrocardiographic criterion and age, sex, body mass index (BMI), waist circumference, and waist:hip ratio (p-entry < 0.05, p-removal > 0.10). T-wave abnormalities or the spatial QRS-T angle (SA) were added to the improved models. The study population had a mean (SD) age of 56 (6) years, BMI of 26.1 (4.0) kg/m2 and 46% were men. MRI-LVH was present in 10% of participants. The c-statistic for Sokolow–Lyon voltage was 0.58, R2 was 0.02 and sensitivity at 90% specificity was 16%, for Sokolow–Lyon product this was 0.62, 0.02, and 21%, for Cornell voltage 0.65, 0.04, and 28% and for Cornell product 0.67, 0.04, and 25%. Best performing models were obtained by addition of both BMI and SA (Sokolow-Lyon voltage: c-statistic 0.74, R2 0.11, sensitivity of 41% at 90% specificity; Sokolow-Lyon product: 0.75, 0.12, 42%; Cornell voltage: c-statistic 0.70, R2 0.08, sensitivity of 38% at 90% specificity; Cornell product: c-statistic 0.72, R2 0.08, sensitivity of 44% at 90% specificity). Electrocardiographic detection of LVH improved by adding BMI and SA to a model with conventional electrocardiographic criteria. This approach would require little extra effort and application in clinical practice is feasible. However, results should first be replicated in high-risk populations.

Tài liệu tham khảo

Kannel WB, Gordon T, Offutt D. Left ventricular hypertrophy by electrocardiogram. Prevalence, incidence, and mortality in the Framingham study. Ann Intern Med. 1969;71(1):89–105.

Hawkins NM, Wang D, McMurray JJ, et al. Prevalence and prognostic implications of electrocardiographic left ventricular hypertrophy in heart failure: evidence from the CHARM programme. Heart. 2007;93(1):59–64.

Pewsner D, Juni P, Egger M, Battaglia M, Sundström J, Bachmann LM. Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review. BMJ. 2007;335(7622):711.

Masui A, Tsuji H, Tamura K, et al. Effect of body characteristics on the variables of signal-averaged electrocardiograms in healthy subjects. Chest. 1994;105(5):1357–9.

Cuspidi C, Facchetti R, Bombelli M, et al. Does QRS voltage correction by body mass index improve the accuracy of electrocardiography in detecting left ventricular hypertrophy and predicting cardiovascular events in a general population? J Clin Hypertens (Greenwich). 2016;18(5):415–21.

Angeli F, Verdecchia P, Iacobellis G, Reboldi G. Usefulness of QRS voltage correction by body mass index to improve electrocardiographic detection of left ventricular hypertrophy in patients with systemic hypertension. Am J Cardiol. 2014;114(3):427–32.

Robinson C, Woodiwiss AJ, Libhaber CD, Norton GR. Novel approach to the detection of left ventricular hypertrophy using body mass index-corrected electrocardiographic voltage criteria in a group of African ancestry. Clin Cardiol. 2016;39(9):524–30.

Norman JE Jr, Levy D. Adjustment of ECG left ventricular hypertrophy criteria for body mass index and age improves classification accuracy. The effects of hypertension and obesity. J Electrocardiol. 1996;29:241–7.

Xu X, Rials SJ, Wu Y, et al. Left ventricular hypertrophy decreases slowly but not rapidly activating delayed rectifier potassium currents of epicardial and endocardial myocytes in rabbits. Circulation. 2001;103(11):1585–90.

Pye MP, Cobbe SM. Mechanisms of ventricular arrhythmias in cardiac failure and hypertrophy. Cardiovasc Res. 1992;26(8):740–50.

Draisma HH, Schalij MJ, van der Wall EE, Swenne CA. Elucidation of the spatial ventricular gradient and its link with dispersion of repolarization. Heart Rhythm. 2006;3(9):1092–9.

Man S, Rahmattulla C, Maan AC, et al. Role of the vectorcardiogram-derived spatial QRS-T angle in diagnosing left ventricular hypertrophy. J Electrocardiol. 2012;45(2):154–60.

de Mutsert R, den Heijer M, Rabelink TJ, et al. The Netherlands Epidemiology of Obesity (NEO) study: study design and data collection. Eur J Epidemiol. 2013;28(6):513–23.

Blackburn H, Keys A, Simonson E, Rautaharju P, Punsar S. The electrocardiogram in population studies. A classification system. Circulation. 1960;21:1160–75.

Sokolow M, Lyon TP. The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J. 1949;37(2):161–86.

Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P. Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings. Circulation. 1987;75(3):565–72.

Molloy TJ, Okin PM, Devereux RB, Kligfield P. Electrocardiographic detection of left ventricular hypertrophy by the simple QRS voltage-duration product. J Am Coll Cardiol. 1992;20(5):1180–6.

Okin PM, Roman MJ, Devereux RB, Kligfield P. Electrocardiographic identification of increased left ventricular mass by simple voltage-duration products. J Am Coll Cardiol. 1995;25(2):417–23.

Kors JA, van Herpen G, Sittig AC, van Bemmel JH. Reconstruction of the Frank vectorcardiogram from standard electrocardiographic leads: diagnostic comparison of different methods. Eur Heart J. 1990;11(12):1083–92.

Man SC, Maan AC, van der Wall EE, Schalij MJ, Swenne CA. Beats: an interactive research oriented ECG analysis system. Comput Cardiol. 2010;37:1007–10.

Draisma HHM, Swenne CA, van der Vooren H, et al. LEADS: an interactive research oriented ECG/VCG analysis system. Comput Cardiol. 2005;32:515–8.

Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440–63.

Sutton-Tyrrell K, Newman A, Simonsick EM, et al. Aortic stiffness is associated with visceral adiposity in older adults enrolled in the study of health, aging, and body composition. Hypertension. 2001;38(3):429–33.

Fraley MA, Birchem JA, Senkottaiyan N, Alpert MA. Obesity and the electrocardiogram. Obes Rev. 2005;6(4):275–81.

Cuspidi C, Rescaldani M, Sala C, Grassi G. Left-ventricular hypertrophy and obesity: a systematic review and meta-analysis of echocardiographic studies. J Hypertens. 2014;32(1):16–25.

Hansen DE. Mechanoelectrical feedback effects of altering preload, afterload, and ventricular shortening. Am J Physiol. 1993;264(2 Pt 2):H423–32.

Winterton SJ, Turner MA, O’Gorman DJ, Flores NA, Sheridan DJ. Hypertrophy causes delayed conduction in human and guinea pig myocardium: accentuation during ischaemic perfusion. Cardiovasc Res. 1994;28(1):47–54.

McIntyre H, Fry CH. Abnormal action potential conduction in isolated human hypertrophied left ventricular myocardium. J Cardiovasc Electrophysiol. 1997;8(8):887–94.

Dilaveris P, Gialafos E, Pantazis A, Synetos A, Triposkiadis F, Gialafos J. The spatial QRS-T angle as a marker of ventricular repolarisation in hypertension. J Hum Hypertens. 2001;15(1):63–70.

Oikarinen L, Vaananen H, Dabek J, et al. Relation of twelve-lead electrocardiographic T-wave morphology descriptors to left ventricular mass. Am J Cardiol. 2002;90(9):1032–5.

Thông tin
Thông tin xuất bản

Cardiology and Therapy

Tập 8

345-356

Thông tin tác giả