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Electrocardiographic criteria of left ventricular hypertrophy in general population

  • Cardiovascular Disease
  • Published:
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Abstract

The question on whether the electrocardiographic criteria are reliable for detection of left ventricular hypertrophy (LVH) and play a role in predicting outcome is open. Answer can only proceed from population-based studies over unselected people followed up for years. In this study, 1,699 subjects from general population underwent echocardiogram and standard electrocardiogram (ECG) codified for LVH with Minnesota code and with other five methods. Other items were also recorded and used as covariables. Left ventricular mass index (LVMI) was 127.6 ± 44.9 g m−2 in men and 120.8 ± 41.2 g m−2 in women, and correlated directly with age in both genders. Prevalence of echocardiographic LVH was 36.6% in men and 53.4% in women. LVMI correlated directly with the Sokolow–Lyon score in both genders at any age, with the Romhilt–Estes, Cornell and RaVL scores in all subjects but elderly men, and with the Lewis score in men and women aged ≤69 years. Sensitivity and the predictive value of electrocardiographic tests, as well as the prevalence of LVH diagnosed with electrocardiographic criteria, were always low. Specificity was high for all the tests, and in particular for the Cornell index. Only when diagnosed with echocardiogram or with the Sokolow–Lyon criterion, LVH was an independent predictor of mortality. We conclude that electrocardiographic tests cannot be used as a surrogate of echocardiogram in detecting LVH in the general population because their positive predictive value (PPV) is unacceptably low. On the contrary, they could replace echocardiography in the follow up and for prediction of outcome, when LVH has previously been correctly diagnosed with other methods.

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Abbreviations

CASTEL:

CArdiovascular STudy in the ELderly

CI:

Confidence interval

ECG:

Electrocardiogram

EDIVS:

End-diastolic inter-ventricular septum

FN:

False negative

FP:

False positive

LEOGRA:

Last Evidences of Genetic risk factors in the Aged

LVEDD:

Left ventricular end-diastolic diameter

LVEDPWT:

Left ventricular posterior wall thickness

LVH:

Left ventricular hypertrophy

LVM:

Left ventricular mass

LVMI:

Left ventricular mass index

NPV:

Negative predictive value

PPV:

Positive predictive value

RR:

Relative risk

VN:

Very negative

VP:

Very positive

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Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, University of Padova, Via Giustiniani No. 2, 35128, Padova, Italy

    Edoardo Casiglia, Laura Schiavon, Valérie Tikhonoff, Anna Bascelli, Francesco Bagato, Monica Bolzon, Federica Guidotti, Hilda Haxhi Nasto & Achille C. Pessina

  2. Department of Cardiology, General Hospital of Schio, Schio, Italy

    Bortolo Martini

  3. Department of Internal Medicine, General Hospital of Rovigo, Rovigo, Italy

    Alberto Mazza

  4. Department of Cardiology, General Direction and Data Elaboration Centre, General Hospital of Thiene, Thiene, Italy

    Sandro Caffi & Mario Saugo

  5. Department of Cardiology, Hospital of Mirano, Mirano, Italy

    Daniele D′Este

  6. Department of Cardiology, Hospital of Thiene, Thiene, Italy

    Francesco Guglielmi

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  1. Edoardo Casiglia
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Correspondence to Edoardo Casiglia.

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Casiglia, E., Schiavon, L., Tikhonoff, V. et al. Electrocardiographic criteria of left ventricular hypertrophy in general population. Eur J Epidemiol 23, 261–271 (2008). https://doi.org/10.1007/s10654-008-9234-6

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