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Gender differences in the diagnosis and treatment of left ventricular hypertrophy detected by different electrocardiographic criteria. Findings from the SARA study

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Abstract

This study examines the influence of gender on the detection of left ventricular hypertrophy (LVH) by different electrocardiographic (ECG) criteria and the potential changes induced by antihypertensive therapy from the SARA study (“eStudio del trAtamiento con candesaRtan en pacientes con hipertensión Arterial según criterios electrocardiográficos”) database. The SARA study was aimed to determine the effect of a 12-month candesartan-based regimen on ECG-LVH. Overall, 264 patients were included. Cornell voltage index (CorV), Cornell product (CorP), Sokolow-Lyon voltage index (SokV), and Sokolow-Lyon product (SokP) were calculated. At baseline, 39.3% of women and 15.4% of men exhibited ECG-LVH by CorP criteria, and 18.2% of women and 30.6% of men had LVH by SokP. When voltage criteria were applied, LVH was detected in 20.5% of women and 5.9% of men by CorV, and in 10.7% and 13.4%, respectively, by SokV. At the end of the study, the proportion of patients with ECG-LVH by CorP was 28.7% in women (P < 0.001) and 14.4% in men (P = not significant [n.s.]), and in 21.2% (P = n.s.) and 22.1% (P = 0.01) by SokP. Left ventricular hypertrophy by CorV were present in 17.9% of women and 9.0% of men (both P = 0.001), and in 10.6% and 13.3%, respectively by SokV (both P = n.s.). In ECG-LVH hypertensive patients, candesartan was an efficacious drug to regress LVH in the clinical practice setting. The voltage-duration product criteria suggestively detected ECG-LVH and its respective changes better than voltage criteria. Although in daily clinical practice the use of both product criteria seemed clearly preferable to voltage for assessment of ECG-LVH, the CorP appeared to be markedly more useful in women and SokP in men.

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References

  1. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Boudier HA, Zanchetti A, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Erdine S, Kiowski W, Agabiti-Rosei E, Ambrosioni E, Lindholm LH, Viigimaa M, Adamopoulos S, Agabiti-Rosei E, Ambrosioni E, Bertomeu V, Clement D, Erdine S, Farsang C, Gaita D, Lip G, Mallion JM, Manolis AJ, Nilsson PM, O’Brien E, Ponikowski P, Redon J, Ruschitzka F, Tamargo J, van Zwieten P, Waeber B, Williams B (2007) 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 25:1105–1187

    Article  CAS  PubMed  Google Scholar 

  2. European Society of Hypertension-European Society of Cardiology Guidelines Committee (2003) 2003 European Society of Hypertension-European Society of Cardiology guidelines for management of arterial hypertension. J Hypertens 21:1011–1153

    Article  Google Scholar 

  3. Barrios V, Escobar C, Calderon A, Ribas L, Marti D, Asin E (2008) Prevalence of left ventricular hypertrophy detected by Cornell voltage-duration product in a hypertensive population. Blood Press 17:110–115

    Article  PubMed  Google Scholar 

  4. Kim H, Cho HO, Cho YK, Nam CW, Han SW, Hur SH, Kim KS, Kim YN, Kim KB (2008) Relationship between early diastolic strain rate imaging and left ventricular geometric patterns in hypertensive patients. Heart Vessels 23:271–278

    Article  PubMed  Google Scholar 

  5. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP (1990) Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 322:1561–1566

    Article  CAS  PubMed  Google Scholar 

  6. Okin PM, Devereux RB, Jern S, Kjeldsen SE, Julius S, Nieminen MS, Snapinn S, Harris KE, Aurup P, Edelman JM, Wedel H, Lindholm LH, Dahlöf B (2004) Regression of electrocardiographic left ventricular hypertrophy during antihypertensive treatment and the prediction of mayor cardiovascular events. JAMA 292: 2343–2349

    Article  CAS  PubMed  Google Scholar 

  7. Verdecchia P, Angeli F, Borgioni C, Gattobigio R, de Simone G, Devereux RB, Porcellati C (2003) Changes in cardiovascular risk by reduction of left ventricular mass in hypertension: a meta-analysis. Am J Hypertens 16:895–899

    Article  PubMed  Google Scholar 

  8. Ge CJ, Lu SZ, Chen YD, Wu XF, Hu SJ, Ji Y (2008) Synergistic effect of amlodipine and atorvastatin on blood pressure, left ventricular remodeling, and C-reactive protein in hypertensive patients with primary hypercholesterolemia. Heart Vessels 23:91–95

    Article  PubMed  Google Scholar 

  9. Alfakih K, Walters K, Jones T, Ridgway J, Hall AS, Sivananthan M (2004) New gender-specific partition values for ECG criteria of left ventricular hypertrophy. Recalibration against cardiac MRI. Hypertension 44:175–179

    Article  CAS  PubMed  Google Scholar 

  10. Barrios V, Escobar C, Calderón A, Tomís JP, Ruiz S, Moya JL, Megías A, Vegazo O, Fernandez R (2006) Regression of left ventricular hypertrophy by a candesartan-based regimen in clinical practice. The VIPE Study. J Renin Angiotensin Aldosterone Syst 7:236–242

    Article  CAS  PubMed  Google Scholar 

  11. Dahlöf B, Devereux RB, Julius S, Kjeldsen SE, Beevers G, de Faire U, Fyhrquist F, Hedner T, Ibsen H, Kristianson K, Lederballe-Pedersen O, Lindholm LH, Nieminen MS, Omvik P, Oparil S, Wedel H (1998) Characteristics of 9194 patients with left ventricular hypertrophy. The LIFE Study. Hypertension 32:989–997

    PubMed  Google Scholar 

  12. Barrios V, Calderón A, Escobar C, Barrios S, Navarro-Cid J, González-Pedel V, Vegazo O, Fernandez R (2007) Electrocardiographic left ventricular hypertrophy regression induced by an angiotensin receptor blocker-based regimen in daily clinical practice. The SARA study. J Hypertens 25: 1967–1973

    Article  CAS  PubMed  Google Scholar 

  13. Escobar C, Barrios V, Calderón A, Barrios S, Echarri R, Navarro-Cid J, Ferrer E, Fernandez R (2008) Electrocardiographic left ventricular hypertrophy regression induced by an angiotensin receptor blocker-based regimen in hypertensive patients with the metabolic syndrome. Data from the SARA study. J Clin Hypertens 10:208–214

    Article  CAS  Google Scholar 

  14. Okin PM, Devereux RB, Jern S, Kjeldsen SE, Julius S, Dahlöf B (2000) Baseline characteristics in relation to electrocardiographic left ventricular hypertrophy in hypertensive patients: the Losartan Intervention For Endpoint (LIFE) reduction in hypertension study. Hypertension 36:766–773

    CAS  PubMed  Google Scholar 

  15. Gonzalez-Juanatey JR, Cea-Calvo L, Bertomeu V, Aznar J (2007) Electrocardiographic criteria for left ventricular hypertrophy and cardiovascular risk in hypertensives. VIIDA study. Rev Esp Cardiol 60:148–156

    Article  Google Scholar 

  16. Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P (1987) Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings. Circulation 75: 565–572

    CAS  PubMed  Google Scholar 

  17. Okin PM, Roman MJ, Devereux RB, Pickering TG, Borer JS, Kligfield P (1998) Time-voltage area of the 12-lead electrocardiogram. Detection of left ventricular hypertrophy. Hypertension 31:937–942

    CAS  Google Scholar 

  18. Bella JN, Devereux RB (2006) Is echocardiography essential in the management of newly diagnosed hypertension? Am J Hypertens 19:1156–1157

    Article  PubMed  Google Scholar 

  19. Bacharova L (2007) Electrical and structural remodeling in left ventricular hypertrophy — a substrate for a decrease in QRS voltage? Ann Noninvasive Electrocardiol 12:260–273

    Article  PubMed  Google Scholar 

  20. Bacharova L (2008) The “high-voltage trap” in the electrocardiographic diagnosis of left ventricular hypertrophy. J Electrocardiol 41:351–352

    Article  PubMed  Google Scholar 

  21. Gerdts E, Okin PM, de Simone G, Cramariuc D, Wachtell K, Boman K, Devereux RB (2008) Gender differences in left ventricular structure and function during antihypertensive treatment: the Losartan Intervention for Endpoint Reduction in Hypertension Study. Hypertension 51:1109–1114

    Article  CAS  PubMed  Google Scholar 

  22. Mizia-Stec K, Gasior Z, Zahorska-Markiewicz B, Holecki M, Haberka M, Mizia M, Gomułka S, Zak-Gołab A, Gościńska A (2008) The indexes of arterial structure and function in women with simple obesity: a preliminary study. Heart Vessels 23:224–229

    Article  PubMed  Google Scholar 

  23. Okin PM, Gerdts E, Kjeldsen SE, Julius S, Edelman JM, Dahlöf B, Devereux RB (2008) Gender differences in regression of electrocardiographic left ventricular hypertrophy during antihypertensive therapy. Hypertension 52:100–106

    Article  CAS  PubMed  Google Scholar 

  24. Escobar C, Barrios V (2008) Gender differences in left ventricular hypertrophy regression. Hypertension 51:e58

    Article  CAS  PubMed  Google Scholar 

  25. Os I, Franco V, Kjeldsen SE, Manhem K, Devereux RB, Gerdts E, Hille DA, Lyle PA, Okin PM, Dahlöf B, Oparil S (2008) Effects of losartan in women with hypertension and left ventricular hypertrophy: results from the Losartan Intervention for Endpoint Reduction in Hypertension Study. Hypertension 51:1103–1108

    Article  CAS  PubMed  Google Scholar 

  26. Angeli F, Verdecchia P, Angeli E, Poeta F, Sardone M, Bentivoglio M, Prosciutti L, Cocchieri M, Zollino L, Bellomo G, Rondoni F, Garognoli O, Lenti S, Frigerio C, Gattobigio R, Benemio G, Biscottini B, Panciarola R, Buccolieri M, Liberati R, Trottini M, Cipollini F, Gemelli F, Schillaci G, Porcellati C (2006) Day-to-day variability of electrocardiographic diagnosis of left ventricular hypertrophy in hypertensive patients. Influence of electrode placement. J Cardiovasc Med (Hagerstown) 7: 812–816

    Google Scholar 

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Correspondence to Vivencio Barrios.

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Barrios, V., Escobar, C., Calderón, A. et al. Gender differences in the diagnosis and treatment of left ventricular hypertrophy detected by different electrocardiographic criteria. Findings from the SARA study. Heart Vessels 25, 51–56 (2010). https://doi.org/10.1007/s00380-009-1154-1

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