title: Examining QRS amplitude criteria for electrocardiographic left ventricular hypertrophy in recommendations for screening criteria in athletes.
abstract: BACKGROUND
  Current guidelines for interpretation of the ECGs of athletes recommend that isolated R and S wave amplitudes that exceed traditional criteria for left ventricular hypertrophy be accepted as a physiological response to exercise training. This is based on training and echocardiographic studies but not on long term follow up. Demonstration of the prognostic characteristics of the amplitude criteria in a non-athletic population could support the current guidelines.
  
  
  OBJECTIVE
  To evaluate the prognostic value of the R and S wave voltage criteria for electrocardiographic left ventricular hypertrophy (ECG-LVH) in an ambulatory clinical population.
  
  
  METHODS
  The target population consisted of 20,903 ambulatory subjects who had ECGs recorded between 1987 and 1999 and were followed for cardiovascular death until 2013. During the mean follow up of 17 years, there were 881 cardiovascular deaths.
  
  
  RESULTS
  The mean age was 43 ± 10, 91% were male and 16% were African American. Of the 2482 (12%) subjects who met the Sokolow-Lyon criteria, 241 (1.2%) subjects with left ventricular (LV) strain had an HR of 5.4 (95% CI 4.1-7.2, p<0.001), while 2241 (11%) subjects without strain had an HR of 1.4 (95% CI 1.2-1.8, p<0.001). Of the 4836 (23%) subjects who met the Framingham voltage criteria, 350 (2%) subjects with LV strain had an HR of 5.1 (95% CI 4.0-6.5, p<0.001), while 4486 (22%) subjects without strain had an HR of 1.1 (95% CI 0.9-1.3, p=0.26). The individual components of the Romhilt-Estes had HRs ranging from 1.4 to 3.6, with only the voltage component not being significant (HR 1.1, 95% CI 0.9-1.5, p=0.35).
  
  
  CONCLUSIONS
  This study demonstrates that the R and S wave voltage criteria components of most of the original classification schema for electrocardiographic left ventricular hypertrophy are not predictive of CV mortality. Our findings support the current guidelines for electrocardiographic screening of athletes.
authors: Saint Louis University School of Medicine, St. Louis, MO. Electronic address: vsingla@slu.edu.
authors: Varun
authors: V
authors: Singla
authors: Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; University of California, Irvine, CA.
authors: Akash
authors: A
authors: Jindal
authors: The Division of Cardiovascular Medicine, Department of Medicine, Stanford School of Medicine, Stanford, CA 94305.
authors: Vedant
authors: V
authors: Pargaonkar
authors: Ohio State University School of Medicine, Columbus, OH.
authors: Muhammad
authors: M
authors: Soofi
authors: The Division of Cardiovascular Medicine, Department of Medicine, Stanford School of Medicine, Stanford, CA 94305.
authors: Matthew
authors: M
authors: Wheeler
authors: The Division of Cardiovascular Medicine, Department of Medicine, Stanford School of Medicine, Stanford, CA 94305; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
authors: Victor
authors: V
authors: Froelicher
mesh_terms: D000293:Adolescent; D000328:Adult; D056352:Athletes / Q000706:statistics & numerical data*; D002140:California / Q000453:epidemiology; D002648:Child; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control; D003936:Diagnosis, Computer-Assisted / Q000379:methods / Q000706:statistics & numerical data; D003955:Diagnostic Tests, Routine / Q000592:standards / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D042241:Early Diagnosis; D004562:Electrocardiography / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000401:mortality*; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods / Q000592:standards; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D055815:Young Adult
keywords: ECG-LVH; LV strain; R and S wave voltage criteria