title: Influence of cigarette smoking on the electrocardiographic diagnosis of left ventricular hypertrophy in arterial hypertension.
abstract: Electrocardiography (ECG) has a lower sensitivity for the diagnosis of left ventricular (LV) hypertrophy in smokers than in non-smokers, but the explanation for this finding is not known. In the setting of the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study, all subjects smoking > or = 15 cigarettes/day (n = 121, 89 men, age 48 +/- 11 years) were selected from 1443 untreated hypertensive subjects undergoing ECG and M-mode echocardiography, and matched with 484 hypertensive non-smokers by gender (same sex), age (+/- 5 years), and systolic and diastolic blood pressure (both +/- 5 mmHg) in a case-to-control design with a 1:4 matching ratio. Smokers and non-smokers did not differ by age, gender, body mass index, and blood pressure. The voltage of SV1 + RV5 or V6 and RI (p < 0.05), but not of SV3 + RaVL, was lower in smokers. Sensitivity of ECG was lower in smokers when using peripheral or left precordial voltage criteria (e.g. 11 vs 26% for Sokolow-Lyon voltage). When using definitions based on different criteria (voltage of S wave in V3, LV axis, LV strain), sensitivity was not dissimilar in smokers and non-smokers (e.g. 19 vs 18% for Romhilt-Estes score, 40 vs 34% for Perugia criterion). Thus, in hypertensive smokers, sensitivity of ECG is lower than in non-smokers when using peripheral or left precordial voltage criteria, probably due to increased chest size in smokers resulting from increased lung compliance. For LV hypertrophy detection, Sokolow-Lyon voltage should be avoided in hypertensive smokers and replaced by other criteria (Cornell voltage, Romhilt-Estes score, Perugia criterion), which are not influenced by cigarette smoking.
authors.affiliation: Divisione di Medicina, Ospedale Beato G. Villa, Città della Pieve, PG, Perugia.
authors.forename: G
authors.initials: G
authors.lastname: Schillaci
authors.forename: P
authors.initials: P
authors.lastname: Verdecchia
authors.forename: N
authors.initials: N
authors.lastname: Sacchi
authors.forename: E
authors.initials: E
authors.lastname: Vignai
authors.forename: G
authors.initials: G
authors.lastname: Benemio
authors.forename: C
authors.initials: C
authors.lastname: Porcellati
mesh_terms: D000328:Adult; D000367:Age Factors; D003627:Data Interpretation, Statistical; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects*