title: Determinants of discrepancies in detection and comparison of the prognostic significance of left ventricular hypertrophy by electrocardiogram and cardiac magnetic resonance imaging.
abstract: Despite the low sensitivity of the electrocardiogram (ECG) in detecting left ventricular hypertrophy (LVH), ECG-LVH is known to be a strong predictor of cardiovascular risk. Understanding reasons for the discrepancies in detection of LVH by ECG versus imaging could help improve the diagnostic ability of ECG. We examined factors associated with false-positive and false-negative ECG-LVH, using cardiac magnetic resonance imaging (MRI) as the gold standard. We also compared the prognostic significance of ECG-LVH and MRI-LVH as predictors of cardiovascular events. This analysis included 4,748 participants (mean age 61.9 years, 53.5% females, 61.7% nonwhites). Logistic regression with stepwise selection was used to identify factors associated with false-positive (n = 208) and false-negative (n = 387), compared with true-positive (n = 208) and true-negative (n = 4,041) ECG-LVH, respectively. A false-negative ECG-LVH status was associated with increased odds of Hispanic race/ethnicity, current smoking, hypertension, increased systolic blood pressure, prolongation of QRS duration, and higher body mass index and with lower odds of increased ejection fraction (model-generalized R(2) = 0.20). A false-positive ECG-LVH status was associated with lower odds of black race, Hispanic race/ethnicity, minor ST-T abnormalities, increased systolic blood pressure, and presence of any major electrocardiographic abnormalities (model-generalized R(2) = 0.29). Both ECG-LVH and MRI-LVH were associated with an increased risk of cardiovascular disease events (hazard ratio 1.51, 95% confidence interval 1.03 to 2.20 and hazard ratio 1.81, 95% confidence interval 1.33 to 2.46, respectively). In conclusion, discrepancy in LVH detection by ECG and MRI can be relatively improved by considering certain participant characteristics. Discrepancy in diagnostic performance, yet agreement on predictive ability, suggests that LVH by ECG and LVH by imaging are likely to be two distinct but somehow related phenotypes.
authors.affiliation: International Laser Center, Bratislava, Slovak Republic.
authors.forename: Ljuba
authors.initials: L
authors.lastname: Bacharova
authors.affiliation: Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Haiying
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: E Harvey
authors.initials: EH
authors.lastname: Estes
authors.affiliation: International Laser Center, Bratislava, Slovak Republic.
authors.forename: Anton
authors.initials: A
authors.lastname: Mateasik
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland; Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Joao A C
authors.initials: JA
authors.lastname: Lima
authors.affiliation: Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Burke
authors.affiliation: Epidemiological Cardiology Research Center (EPICARE), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina. Electronic address: esoliman@wakehealth.edu.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000208:ethnology / Q000503:physiopathology; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D014463:Ultrasonography; D014481:United States / Q000453:epidemiology