title: Electrocardiographic criteria of left ventricular hypertrophy in general population.
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 R(aVL) scores in all subjects but elderly men, and with the Lewis score in men and women aged < or =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.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy. edoardo.casiglia@unipd.it
authors.forename: Edoardo
authors.initials: E
authors.lastname: Casiglia
authors.forename: Laura
authors.initials: L
authors.lastname: Schiavon
authors.forename: Valérie
authors.initials: V
authors.lastname: Tikhonoff
authors.forename: Anna
authors.initials: A
authors.lastname: Bascelli
authors.forename: Bortolo
authors.initials: B
authors.lastname: Martini
authors.forename: Alberto
authors.initials: A
authors.lastname: Mazza
authors.forename: Sandro
authors.initials: S
authors.lastname: Caffi
authors.forename: Daniele
authors.initials: D
authors.lastname: D'Este
authors.forename: Francesco
authors.initials: F
authors.lastname: Bagato
authors.forename: Monica
authors.initials: M
authors.lastname: Bolzon
authors.forename: Federica
authors.initials: F
authors.lastname: Guidotti
authors.forename: Hilda
authors.initials: H
authors.lastname: Haxhi Nasto
authors.forename: Mario
authors.initials: M
authors.lastname: Saugo
authors.forename: Francesco
authors.initials: F
authors.lastname: Guglielmi
authors.forename: Achille C
authors.initials: AC
authors.lastname: Pessina
mesh_terms: D000368:Aged; D004562:Electrocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012680:Sensitivity and Specificity; D016019:Survival Analysis