Ventricular mass and electrocardiographic criteria of hypertrophy: evaluation of new score.
BACKGROUND
The left ventricular hypertrophy (LVH) is an important and independent cardiovascular risk factor. There is a scarcity of studies in Brazil designed to test the efficacy of the electrocardiogram (ECG) in the diagnosis of this important pathological process.


OBJECTIVE
To evaluate a new electrocardiographic score for the diagnosis of LVH by ECG: the sum of the highest amplitude of the S wave and the highest amplitude of the R wave on the horizontal plane, multiplied by the result of the QRS duration [(S+R) X QRS)] and comparing it with the classic electrocardiographic criteria.


METHODS
The echocardiograms and ECG of 1,204 hypertensive patients receiving outpatient care were evaluated. The left ventricular mass index (LVMI) was assessed by the echocardiogram, with a diagnosis of LVH when the LVMI was > or = 96 g/m(2) for women and > or = 116 g/m(2) for men. Four classic criteria of LVH were analyzed at the ECG, in addition to the new score to be tested.


RESULTS
In general, the studied ECG-LVH criteria showed significant statistical correlation to the echocardiographic LVMI. The (R+S) X QRS index, using 2.80 mm.s as the cutoff value, provided test accuracy regarding sensibility and specificity of 35.2% and 88.71%, respectively, representing the best correlation to LVMI (r=0.564) when compared to the other indexes: Romhilt-Estes (r=0.464); Sokolow-Lyon (r=0.419); Cornell voltage (r=0.377); Cornell product r=0.444).


CONCLUSIONS
All the electrocardiographic criteria used for the assessment of the LV mass presented low sensitivity. The new score presented the best correlation with LVMI when compared to the other indexes.
Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP - Brazil.
Cléber do Lago
Cdo L
Mazzaro
Francisco de Assis
Fde A
Costa
Maria Teresa Nogueira
MT
Bombig
Bráulio
B
Luna Filho
Angelo Amato Vincenzo de
AA
Paola
Antonio Carlos de Camargo
AC
Carvalho
William da
Wd
Costa
Francisco Antonio Helfenstein
FA
Fonseca
Rui Manoel dos Santos
RM
Póvoa
D003627:Data Interpretation, Statistical; D004452:Echocardiography; D004562:Electrocardiography / Q000592:standards*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology; D009929:Organ Size; D012372:ROC Curve; D012016:Reference Values; D012680:Sensitivity and Specificity