title: Reliability of electrocardiographic surrogates of left ventricular mass in patients with chronic kidney disease.
abstract: OBJECTIVE
  Left ventricular hypertrophy (LVH) is a prevalent condition in chronic kidney disease (CKD) very often underdiagnosed and misdiagnosed. Electrocardiography (ECG) is an easily accessible LVH diagnostic tool. We evaluated the usefulness of commonly applied ECG criteria for LVH diagnosis in CKD patients.
  
  
  METHODS
  Cross-sectional evaluation of 253 nondialysis-dependent CKD stages 3-5 patients (61 [53-67] years; 65% men). Left ventricular mass (LVM) was assessed by echocardiography (ECHO). ECG was performed to assess Cornell voltage and Sokolow-Lyon voltage and their products (Cornell product and Sokolow-Lyon product, respectively).
  
  
  RESULTS
  The prevalence of LVH ranged from 72 to 89% depending on ECHO criteria used. Cornell product showed the best correlation with ECHO-estimated LVM (ρ = 0.41; P <0.001). Across sex-specific tertiles of ECHO-LVM, ECG criteria increased and patients were more often hypertensive, obese, fluid overloaded, inflamed, and with higher albuminuria. Cornell product showed the strongest association with ECHO-LVM in crude and adjusted regression models, and the higher predictive performance for all the ECHO-based LVH definitions. However, when applying literature-based ECG cut-offs for LVH diagnosis, Sokolow-Lyon product showed a higher specificity. The agreement between ECG criteria cut-offs and ECHO-based definitions of LVH was in general poor, and the number of patients reclassified correctly by ECHO ranged from 77 to 94%.
  
  
  CONCLUSIONS
  Our data suggest that ECG alone is a weak indicator of LVH, and do not support its routine use as a unique tool in the screening of LVH in CKD patients. Further studies are needed to confirm these results and to try establishing adequate cut-offs for LVH diagnosis in this population.
authors: aDepartment of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil bDivisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden cDepartment of Echocardiography dDepartment of Nutrition, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil eCenter for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
authors: Antonio C
authors: AC
authors: Cordeiro
authors: Bengt
authors: B
authors: Lindholm
authors: Márcio G
authors: MG
authors: Sousa
authors: Juliano C
authors: JC
authors: Picotti
authors: Gabriel J
authors: GJ
authors: Nunes
authors: Marcus R O
authors: MR
authors: Santana
authors: Waldyr
authors: W
authors: Grimaldi
authors: Fernanda C
authors: FC
authors: Amparo
authors: Celso
authors: C
authors: Amodeo
authors: Juan J
authors: JJ
authors: Carrero
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D015203:Reproducibility of Results