title: Performance of Sokolow-Lyon index in detection of echocardiographically diagnosed left ventricular hypertrophy in a normal Eastern German population - results of the CARLA study.
abstract: BACKGROUND
  Arterial hypertension is a common disease with high prevalence in the general population. Left ventricular hypertrophy (LVH) is an independent risk factor in arterial hypertension. Electrocardiographic indices like the Sokolow-Lyon index (SLI) are recommended as diagnostic screening methods for LVH. We assessed the diagnostic performance of the SLI in a cohort of a large general population.
  
  
  METHODS
  We used electrocardiographic and echocardiographic data from the prospective, population-based cohort study CARdio-vascular Disease, Living and Ageing in Halle (CARLA). Linear and logistic regression models were used to assess the association of SLI with LVH. To assess the impact of the body-mass-index (BMI), we performed interaction analyses.
  
  
  RESULTS
  AUC of SLI to predict LVH was 55.3 %, sensitivity of the SLI was 5 %, specificity 97 %. We found a significant association of SLI after covariate-adjustment with echocardiographically detected LVH (increase of left-ventricular mass index, LVMI 7.0 g/m(2) per 1 mV increase of SLI, p < 0.0001). However, this association was mainly caused by an association of SLI with the left-ventricular internal diameter (LVIDd, increase of 0.06 cm/m(2) per 1 mV increase of SLI, p < 0.0001). In obese (BMI > 30 kg/m(2)) we found the strongest association with an increase of 9.2 g/m(2) per 1 mV.
  
  
  CONCLUSIONS
  Although statistically significant, relations of SLI and echocardiographic parameters of LVH were weak and mainly driven by the increase in LVIDd, implicating a more eccentric type of LVH in the collective. The relations were strongest when obese subjects were taken into account. Our data do not favour the SLI as a diagnostic screening test to identify patients at risk for LVH, especially in non-obese subjects without eccentric LVH.
authors.affiliation: Department of Medicine III, Martin-Luther-University Halle-Wittenberg, University Hospital Halle / Saale, Ernst-Grube-Str. 40, 06120, Halle/Saale, Germany. jochen.schroeder@uk-halle.de.
authors.forename: Jochen
authors.initials: J
authors.lastname: Schröder
authors.affiliation: Department of Medicine III, Martin-Luther-University Halle-Wittenberg, University Hospital Halle / Saale, Ernst-Grube-Str. 40, 06120, Halle/Saale, Germany. sebastian.nuding@uk-halle.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Nuding
authors.affiliation: Department of Medicine III, Martin-Luther-University Halle-Wittenberg, University Hospital Halle / Saale, Ernst-Grube-Str. 40, 06120, Halle/Saale, Germany. ursula.mueller-werdan@uk-halle.de.|Clinic for Geriatric Medicine of the University Hospital RWTH Aachen, Aachen, Germany. ursula.mueller-werdan@uk-halle.de.
authors.forename: Ursula
authors.initials: U
authors.lastname: Müller-Werdan
authors.affiliation: Department of Medicine III, Martin-Luther-University Halle-Wittenberg, University Hospital Halle / Saale, Ernst-Grube-Str. 40, 06120, Halle/Saale, Germany. karl.werdan@uk-halle.de.
authors.forename: Karl
authors.initials: K
authors.lastname: Werdan
authors.affiliation: Martin-Luther-University Halle-Wittenberg, Institute of Medical Epidemiology, Biostatistics and Informatics, Magdeburger Str. 8, 06112, Halle/Saale, Germany. alexander.kluttig@uk-halle.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kluttig
authors.affiliation: Department of Cardiology and Pneumology, Helios Amper Kliniken Dachau, Krankenhausstr.15, 85221, Dachau, Germany. martin.russ@helios-kliniken.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Russ
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Centre, Im Neuenheimer Feld 581, 69129, Heidelberg, Germany. h.greiser@dkfz.de.
authors.forename: Karin H
authors.initials: KH
authors.lastname: Greiser
authors.affiliation: Department of Medical Informatics, Erasmus Medical Center Rotterdam, Kamer Na-2617, Postbus 2040, 3000 CA, Rotterdam, The Netherlands. j.kors@erasmusmc.nl.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Kors
authors.affiliation: Martin-Luther-University Halle-Wittenberg, Institute of Medical Epidemiology, Biostatistics and Informatics, Magdeburger Str. 8, 06112, Halle/Saale, Germany. johannes.haerting@medizin.uni-halle.de.
authors.forename: Johannes
authors.initials: J
authors.lastname: Haerting
authors.affiliation: Martin-Luther-University Halle-Wittenberg, Institute of Medical Epidemiology, Biostatistics and Informatics, Magdeburger Str. 8, 06112, Halle/Saale, Germany. daniel.medenwald@uk-halle.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Medenwald
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology*; D015331:Cohort Studies; D004452:Echocardiography / Q000592:standards*; D005260:Female; D005859:Germany, East / Q000453:epidemiology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies