Validity of the surface electrocardiogram criteria for right ventricular hypertrophy: the MESA-RV Study (Multi-Ethnic Study of Atherosclerosis-Right Ventricle).
OBJECTIVE
The study aimed to assess the diagnostic properties of electrocardiographic (ECG) criteria for right ventricular hypertrophy (RVH) measured by cardiac magnetic resonance imaging (cMRI) in adults without clinical cardiovascular disease.


BACKGROUND
Current ECG criteria for RVH were based on cadaveric dissection in small studies.


METHODS
MESA (Multi-Ethnic Study of Atherosclerosis) performed cMRIs with complete right ventricle (RV) interpretation on 4,062 participants without clinical cardiovascular disease. Endocardial margins of the RV were manually contoured on diastolic and systolic images. The ECG screening criteria for RVH from the 2009 American Heart Association Recommendations for Standardization and Interpretation of the ECG were examined in participants with and without left ventricular (LV) hypertrophy or reduced ejection fraction. RVH was defined using sex-specific normative equations based on age, height, and weight.


RESULTS
The study sample with normal LV morphology and function (n = 3,719) was age 61.3 ± 10.0 years, 53.5% female, 39.6% Caucasian, 25.5% African American, 21.9% Hispanic, and 13.0% Asian. The mean body mass index was 27.9 ± 5.0 kg/m(2). A total of 6% had RVH, which was generally mild. Traditional ECG criteria were specific (many >95%) but had low sensitivity for RVH by cMRI. The positive predictive values were not sufficiently high as to be clinically useful (maximum 12%). The results did not differ based on age, sex, race, or smoking status, or with the inclusion of participants with abnormal LV mass or function. Classification and regression tree analysis revealed that no combination of ECG variables was better than the criteria used singly.


CONCLUSIONS
The recommended ECG screening criteria for RVH are not sufficiently sensitive or specific for screening for mild RVH in adults without clinical cardiovascular disease.
Department of Medicine, Division of Cardiology, University of California, San Francisco, California.
Isaac R
IR
Whitman
Department of Medicine, Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Vickas V
VV
Patel
Departments of Epidemiology and Prevention and Internal Medicine, Cardiology Section, Epidemiological Cardiology Research Center (EPICARE), Wake Forest University Health Sciences, Winston-Salem, North Carolina.
Elsayed Z
EZ
Soliman
Radiology and Imaging Sciences, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health/Clinical Center, Bethesda, Maryland.
David A
DA
Bluemke
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Amy
A
Praestgaard
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Aditya
A
Jain
Division of Cardiology, Department of Internal Medicine, Wake Forest University Health Sciences, Winston-Salem, North Carolina.
David
D
Herrington
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Joao A C
JAC
Lima
Department of Medicine, Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: kawut@upenn.edu.
Steven M
SM
Kawut
D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000175:diagnosis* / Q000208:ethnology* / Q000503:physiopathology; D018780:Body Surface Potential Mapping / Q000592:standards*; D015331:Cohort Studies; D005006:Ethnicity / Q000208:ethnology*; D005260:Female; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000175:diagnosis* / Q000208:ethnology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
electrocardiogram; magnetic resonance imaging; right ventricular hypertrophy