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Accuracy of ECG indices for diagnosis of left ventricular hypertrophy in people >65 years: results from the ActiFE study

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Abstract

Background

The detection of left ventricular hypertrophy (LVH) is still a common objective of electrocardiography (ECG) in clinical practice.

Aims

The aim of our study was to evaluate the accuracy of LVH ECG indices in people older than 65 recruited from a population-based cohort (ActiFE-Ulm study).

Methods

In 432 subjects (mean age 76.2 ± 5.5 years, 51% male), left ventricular mass was echocardiographically determined (Devereux formula) and indexed (LVMI) to body surface area. Several LVH ECG indices (Lewis voltage, Gubner–Ungerleider voltage, Sokolow–Lyon voltage/product, Cornell voltage/product) were calculated with the help of resting ECG data and compared with the echocardiographic assessment.

Results

Despite echocardiographic signs of LVH [LVMI > 115 (♂) or >95 g/m2 (♀)] in 47.5% of all subjects, diagnostic performance of all ECG indices was generally low. Magnitude of all LVH-indices was mainly predicted by frontal QRS axis in multivariate linear regression analysis. In comparison with the literature data from younger subjects, average frontal QRS axis turned counterclockwise.

Discussion and conclusions

Most probably, age-related counterclockwise turn of frontal QRS axis is mainly explanatory for the decreased magnitude of LVH ECG indices and consecutive worse diagnostic performance of these indices in the elderly. ECG indices for detection of LVH have insufficient predictive values in geriatric subjects and should therefore not be used clinically for this purpose. Nevertheless, due to its established relevancy in cardiac risk stratification in this age group, usage of some established ECG indices might keep its significance even in the age of modern cardiac imaging.

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Acknowledgements

The authors acknowledge the kind support of the team of Division of Sports and Rehabilitation Medicine Ulm, Germany.

Funding

The ActiFE-Ulm study was funded partly by a grant from the Ministry of Science, Research and Arts, State of Baden-Wuerttemberg, Germany, and by own means.

Author information

Authors and Affiliations

  1. Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II (Cardiology), University of Ulm, Leimgrubenweg 14, 89070, Ulm, Germany

    Roman Laszlo, Katia Kunz & Juergen Michael Steinacker

  2. AGAPLESION Bethesda Clinic, Geriatric Center Ulm/Alb-Donau, University of Ulm, Zollernring 26, 89073, Ulm, Germany

    Dhayana Dallmeier & Michael Denkinger

  3. Institute of Epidemiology and Medical Biometry, University of Ulm, Helmholtzstr. 22, 89081, Ulm, Germany

    Jochen Klenk & Dietrich Rothenbacher

  4. Klinik für Herz-& Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany

    Wolfgang Koenig

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  1. Roman Laszlo
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  2. Katia Kunz
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ActiFE Study group

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Correspondence to Roman Laszlo.

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The authors declare that there are no conflicts of interests.

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Ethical approval was granted by the Ethical Committee of the University of Ulm.

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All participants gave written informed consent.

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Laszlo, R., Kunz, K., Dallmeier, D. et al. Accuracy of ECG indices for diagnosis of left ventricular hypertrophy in people >65 years: results from the ActiFE study. Aging Clin Exp Res 29, 875–884 (2017). https://doi.org/10.1007/s40520-016-0667-6

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  • DOI: https://doi.org/10.1007/s40520-016-0667-6

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