title: Detection of incipient left ventricular hypertrophy in mild to moderate arterial hypertension with normal electrocardiogram and echocardiogram: a new use for signal-averaged electrocardiography.
abstract: OBJECTIVE
  To assess signal-averaged electrocardiogram (SAECG) for diagnosing incipient left ventricular hypertrophy (LVH).
  
  
  METHODS
  A study with 115 individuals was carried out. The individuals were divided as follows: GI - 38 healthy individuals; GII - 47 individuals with mild to moderate hypertension and normal findings on echocardiogram and ECG; and GIII - 30 individuals with hypertension and documented LVH. The magnitude vector of the SAECG was analyzed with the high-pass cutoff frequency of 40 Hz through the bidirectional four-pole Butterworth high-pass digital filter. The mean quadratic root of the total QRS voltage (RMST) and the two-dimensional integral of the QRS area of the spectro-temporal map were analyzed between 0 and 30 Hz for the frequency domain (Int FD), and between 40 and 250 Hz for the time domain (Int TD). The electrocardiographic criterion for LVH was based on the Cornell Product. Left ventricular mass was calculated with the Devereux formula.
  
  
  RESULTS
  All parameters analyzed increased from GI to GIII, except for Int FD (GII vs GIII) and RMST log (GII vs GIII). Int TD showed greater accuracy for detecting LVH with an appropriate cutoff > 8 (sensitivity of 55%, specificity of 81%). Positive values (> 8) were found in 56.5% of the G II patients and in 18.4% of the GI patients (p< 0.0005).
  
  
  CONCLUSIONS
  SAECG can be used in the early diagnosis of LVH in hypertensive patients with normal ECG and echocardiogram.
authors.affiliation: Hospital Universitário Pedro Ernesto, UERJ, Rio de Janeiro, RJ, Brazil. arritmia@uerj.br
authors.forename: Paulo
authors.initials: P
authors.lastname: Ginefra
authors.forename: Eduardo C
authors.initials: EC
authors.lastname: Barbosa
authors.forename: Paulo R
authors.initials: PR
authors.lastname: Benchimol Barbosa
authors.forename: Alfredo S
authors.initials: AS
authors.lastname: Bomfim
authors.forename: Sílvia H
authors.initials: SH
authors.lastname: Boghossian
authors.forename: Angelo A
authors.initials: AA
authors.lastname: Salgado
authors.forename: Flávia G
authors.initials: FG
authors.lastname: Brasil
authors.forename: Elizabete A
authors.initials: EA
authors.lastname: Freitas
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Albanesi Filho
mesh_terms: D000328:Adult; D004452:Echocardiography / Q000379:methods; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012815:Signal Processing, Computer-Assisted