Cornell voltage left ventricular hypertrophy predicts all-cause mortality better than Sokolow-Lyon voltage in patients with and without diabetes – data from 183,749 primary care ECGs

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Haxha ◽  
U Pedersen-Bjergaard ◽  
J.B Nielsen ◽  
J Pallisgaard ◽  
R.B Devereux ◽  
...  
Keyword(s):  
Primary Care ◽  
Left Ventricular Hypertrophy ◽  
Predictive Value ◽  
Ventricular Hypertrophy ◽  
Strong Predictor ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Type I ◽  
All Cause Mortality ◽  
Cornell Voltage

Abstract Background Cornell voltage criteria (CL) and Sokolow-Lyon criteria (SL) for electrocardiographic left ventricular hypertrophy (ECG-LVH) are well known predictors of cardiovascular outcome. However, their predictive value may differ according to patient type and remains to be further tested in diabetic mellitus (DM) patients. Purpose The present study aims to determine the prevalence of each ECG-LVH criteria and their respective predictive value in DM patients. Method A retrospective cohort study of individuals age >40 years with digital ECGs from primary care were collected during 2001 to 2011. Data on medication, comorbidity, and outcomes were collected from Danish nationwide registries. DM was defined if individuals were prescribed oral antidiabetics or insulin, if they were diagnosed with DM type I or II, or had a HbA1c>48 mmol/l. Cox multivariable analysis was used for estimating hazard ratio (HR) and 95% confidence intervals (95% CI) for all-cause mortality during follow-up of up to 17 years. Results Included were 183,749 individuals with a digital ECG collected in primary care. A total of 13,003 (7.1%) individuals had DM, they were older (65.8 vs. 61.3 years), had more myocardial infarction (16.1% vs. 5.2%), stroke (14.4% vs. 6.2%), hypertension (35.1% vs. 13.2%), CL LVH (8.0% vs. 5.6%) and more were males (53.3% vs. 45.3%) compared to the non-DM individuals (all p<0.001). CL identified a larger percentage of LVH in DM compared to non-DM individuals (8.0% vs. 5.6%, p<0.001), whereas SL identified similar percentage LVH in DM and non-DM individuals (8.5% vs. 8.1%, p=0.068). In multivariable adjusted analysis CL LVH remained strongly associated with all-cause mortality [HR 1.45 (95% CI: 1.42–1.48)] compared to SL LVH which found only a modest association [HR 1.06 (95% CI: 1.03–1.10)] (Figure 1). Of note, the association of CL LVH and all-cause mortality was even stronger than DM per se. There was no interaction with DM and either ECG LVH criteria (p>0.45). Conclusion Cornell Voltage Left Ventricular Hypertrophy is a strong predictor of mortality in patients with and without diabetes and an independent risk factor compared to hypertension and diabetes. The predictive value was substantially stronger than Sokolow-Lyon Voltage criteria for hypertrophy. Figure 1. LVH and all-cause mortality Funding Acknowledgement Type of funding source: None

scholarly journals Comparative study of echocardiography and electrocardiography criteria for detecting left ventricular hypertrophy in hypertensive patients

2021 ◽  
Vol 9 (11) ◽  
pp. 3364
Author(s):  
Abhishek Golla ◽  
Ramkumar V. S. ◽  
Ashok Kumar P. ◽  
Ravindranath S. ◽  
Indira Ramaiah ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Predictive Value ◽  
Ventricular Hypertrophy ◽  
Tertiary Care ◽  
Total Duration ◽  
Left Ventricular ◽  
Care Hospital ◽  
Framingham Score ◽  
Hypertensive Patients ◽  
Cornell Voltage

Background: The study aimed to compare seven different electrocardiogram (LVH) criteria for diagnosing left ventricular hypertrophy (LVH) with echocardiogram as diagnostic standard in hypertensive patients.Methods: This was a hospital-based, cross-sectional study conducted in out-patient department and at medical wards of a tertiary care hospital at Bangalore. The study was carried out for a total duration of 12 months. All hypertensive patients underwent examination for prevalence of LVH using echocardiogram and ECG. Seven different ECG criteria were applied to diagnose the presence of LVH. Then the specificity, sensitivity, kappa measurement value, positive predictive value and negative predictive value for all criteria was calculated subsequently.Results: Out of the 100 patients studied, 34 had LVH as diagnosed by echocardiography. Sokolow-Lyon criteria had a sensitivity of 35% and specificity of 94%. Cornell voltage had a sensitivity of 26% and specificity of 95%. Modified Cornell voltage had a sensitivity of32% and specificity of 94%. Framingham adjusted Cornell voltage, Minnesota code and Cornell product had a sensitivity of 23.5% and specificity of 98.4%. Framingham score had a sensitivity of 38% and specificity of 95.4%.Conclusions: It can be concluded that among all the different criteria used in the study, Framingham score showed better sensitivity compared to others. In the evaluation of hypertensive patients for LVH, the role of ECG with all the commonly used criteria is of limited value and echocardiography is the method of choice.

scholarly journals Prevalence and associated factors of electrocardiographic left ventricular hypertrophy in a rural community, central Thailand

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Patipan Viwatrangkul ◽  
Sakda Lawanwisut ◽  
Pondfah Leekhaphan ◽  
Tatchamon Prasart-intara ◽  
Pathomphon Phiensuparp ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Rural Community ◽  
Associated Factors ◽  
Ventricular Hypertrophy ◽  
Strong Predictor ◽  
Hypertensive Crisis ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
Cross Sectional ◽  
Cardiac Condition

AbstractLeft ventricular hypertrophy (LVH) is considered a cardiac condition with life-threatening complications. Detected LVH is a strong predictor of cardiovascular diseases and death. This condition is normally diagnosed at offices. We aimed to determine the prevalence and associated factors of electrocardiographic-LVH (ECG-LVH) among adults in a Thai rural community. A cross-sectional study was conducted in Na-Yao rural community of Thailand in 2020. A total of 638 individuals aged ≥ 20 years were interviewed using standardized structured questionnaires related to demographic information, risk behaviors, comorbidities and anthropometric measurements. LVH was determined by Sokolov-Lyon and Cornell criteria based on the collected electrocardiograms. The prevalence of ECG-LVH among adults was 6.6%. The factors independently associated with ECG-LVH were being male (AORs 2.04, 95% CI 1.05–3.98), history of diabetes mellitus (AORs 1.01, 95% CI 1.01–1.02), and hypertensive crisis ≥ 180/110 mmHg (AORs 7.24, 95% CI 1.31–39.92). However, resting heart rate was negatively associated with ECG-LVH (p < 0.05). Our data emphasized that LVH was one of the significant health problems among adults in a rural community. This condition could lead to severe complications. Thus, effective detection and public health interventions should be provided at the community level.

scholarly journals Prevalence and pattern of echocardiographic abnormalities among patients on haemodialysis at an urban hospital in Central Uganda

2020 ◽  
Vol 23 (1) ◽  
Author(s):  
Grace Kansiime ◽  
Robert Kalyesubula ◽  
Emmy Okello ◽  
Ponsiano Ocama
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Diastolic Dysfunction ◽  
Ventricular Hypertrophy ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Sub Saharan Africa ◽  
Chronic Haemodialysis ◽  
Urban Hospital ◽  
Cardiac Abnormalities ◽  
High Prevalence

Background: Cardiovascular disease is the most common cause of morbidity and premature mortality in patients on chronic haemodialysis. There are limited data on cardiac abnormalities among these patients in sub-Saharan Africa, including Uganda. We determined the prevalence and patterns of echocardiographic (echo) abnormalities among patients with end-stage renal disease (ESRD) on haemodialysis at Mulago National Referral Hospital, Kampala, Uganda. Methods: Eighty patients with ESRD on chronic haemodialysis were enrolled in the study over a period of five months from November 2017 to March 2018. We collected data on demographic and baseline clinical characteristics by reviewing charts and conducting patient interviews. Participants had blood pressure measurements performed and blood samples taken for laboratory investigations. We then conducted a cardiac evaluation using standard transthoracic echo protocols. Bivariable and multivariable analysis was performed to study associations with left ventricular hypertrophy and diastolic dysfunction. Results: Fifty-three of the 80 patients (66%) were male, mean age was 49 ± 16 years and the median duration on dialysis was 9.5 months (interquartile range 4–24 months). Twenty-eight (35%) had to travel >50 km to access dialysis. Seventy-four patients (93%) had at least one cardiac echo abnormality and 30% had at least three abnormalities. Left ventricular hypertrophy (68%) and diastolic dysfunction (64%) were the most common abnormalities. There was a high prevalence of factors that have previously been associated with left ventricular hypertrophy and diastolic dysfunction including anaemia (79%), poorly controlled hypertension (79%) and dyslipidaemia (56%) but none of these was statistically significantly associated in this study. Conclusions: Our study confirmed a high prevalence of cardiac abnormalities among a young population of African patients with ESRD on chronic dialysis. We recommend that echocardiography be part of the routine care to help plan early intervention for those at high risk of cardiovascular events.

scholarly journals Performance of Electrocardiographic Criteria for Echocardiographically Diagnosed Left Ventricular Hypertrophy in Chinese Hypertensive Patients

2020 ◽  
Vol 33 (9) ◽  
pp. 831-836 ◽  
Author(s):  
Dian Wang ◽  
Jian-Zhong Xu ◽  
Wei Zhang ◽  
Yi Chen ◽  
Jian Li ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
High Specificity ◽  
Left Ventricular ◽  
Hypertensive Patients ◽  
Receiver Operating Characteristic Curves ◽  
Low Sensitivity ◽  
Ecg Criteria ◽  
Cornell Voltage ◽  
Cornell Product

Abstract BACKGROUND Performance of electrocardiographic (ECG) criteria for echocardiographically diagnosed left ventricular hypertrophy (LVH) in Chinese hypertensive patients is not well known. We investigated the accuracy of various ECG criteria for the diagnosis of the echocardiographic LVH according to the new cutoff values of left ventricular mass (LVM) index (&gt;115 g/m2 for men and &gt;95 g/m2 for women) in Chinese hypertensive patients. METHODS Our study included 702 consecutive hypertensive inpatients including 92 (13.1%) concentric and 121 (17.2%) eccentric LVH on standard echocardiography. Diagnostic accuracy of 7 ECG criteria was evaluated by calculating sensitivity and specificity and by using the receiver operating characteristic curves. RESULTS The ECG criteria for the detection of the echocardiographically defined LVH had a sensitivity of 15%–31.9% and specificity of 91.6%–99.2% overall, 20.7%–43.5% and 91.6%–99.2% concentric, and 7.4%–23.1% and 91.6%–99.2% eccentric. ECG diagnosis of LVH defined as the positive diagnosis of any of 4 ECG criteria including Sokolow–Lyon voltage, Cornell voltage, Cornell product, and RavL voltage had a sensitivity of 54% and specificity of 86.3% overall, 71.7% and 86.3% concentric, and 40.5% and 86.3% eccentric. After adjustment for confounding factors, various ECG criteria were significantly correlated with LVM, with standardized β coefficients from 0.20 to 0.39 (P &lt; 0.001) and the highest coefficient for the Cornell product criterion. CONCLUSIONS All ECG LVH indexes had low sensitivity and high specificity in Chinese hypertensive patients. Combination of 4 or all ECG criteria might improve sensitivity without any loss of specificity.

scholarly journals The Ca2+-activated cation channel TRPM4 is a positive regulator of pressure overload-induced cardiac hypertrophy

2020 ◽  
Author(s):  
Yang Guo ◽  
Ze-Yan Yu ◽  
Jianxin Wu ◽  
Hutao Gong ◽  
Scott Kesteven ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Transient Receptor Potential ◽  
Strong Predictor ◽  
Pressure Overload ◽  
Left Ventricular ◽  
Cation Channel ◽  
Systemic Hypertension ◽  
Mechanosensory Transduction ◽  
Trpm4 Channel

AbstractPathological left ventricular hypertrophy (LVH) is a consequence of pressure overload caused by systemic hypertension or aortic stenosis and is a strong predictor of cardiac failure and mortality. Understanding the molecular pathways in the development of pathological LVH may lead to more effective treatment. Here, we show that the transient receptor potential cation channel subfamily melastatin 4 (TRPM4) ion channel is an important contributor to the mechanosensory transduction of pressure overload that induces LVH. In mice with pressure overload induced by transverse aortic constriction (TAC) for two weeks, cardiomyocyte TRPM4 expression was reduced, as compared to control mice. Cardiomyocyte-specific TRPM4 inactivation reduced by ~50% the degree of TAC-induced LVH, as compared with wild type (WT). In WT mice, TAC activated the CaMKIIδ-HDAC4-MEF2A but not the calcineurin-NFAT-GATA4 pathway. In TRPM4 knock-out mice, activation of the CaMKIIδ-HDAC4-MEF2A pathway by TAC was significantly reduced. However, consistent with a reduction in the known inhibitory effect of CaMKIIδ on calcineurin activity, reduction in the CaMKIIδ-HDAC4-MEF2A pathway was associated with partial activation of the calcineurin-NFAT-GATA4 pathway. These findings indicate that the TRPM4 channel and its cognate signalling pathway are potential novel therapeutic targets for the prevention of pathological pressure overload-induced LVH.Significance statementPathological left ventricular hypertrophy (LVH) occurs in response to pressure overload and remains the single most important clinical predictor of cardiac mortality. Preventing pressure overload LVH is a major goal of therapeutic intervention. Current treatments aim to remove the stimulus for LVH by lowering elevated blood pressure or replacing a stenotic aortic valve. However, neither of these interventions completely reverses adverse cardiac remodelling. Although numerous molecular signalling steps in the induction of LVH have been identified, the initial step by which mechanical stretch associated with cardiac pressure overload is converted into a chemical signal that initiates hypertrophic signalling, remains unresolved. Here, we demonstrate that the TRPM4 channel is a component of the mechanosensory transduction pathway that ultimately leads to LVH.

Abstract P253: Genome-Wide Association Study of Electrocardiographic Left Ventricular Hypertrophy among Persons of European Ancestry: the Kaiser Permanente/UCSF GERA Cohort

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Carlos Iribarren ◽  
Ling Shen ◽  
Alfred D Round ◽  
Edward McNulty ◽  
Peter M Okin ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Genome Wide Association Study ◽  
Left Ventricular ◽  
Genome Wide Association ◽  
European Ancestry ◽  
Kaiser Permanente ◽  
Men And Women ◽  
Genome Wide ◽  
Cornell Voltage

Electrocardiographic (ECG)-derived left ventricular hypertrophy (LVH) is a recognized phenotype of hypertensive target organ damage and an independent risk factor for cardiovascular disease morbidity and mortality, and has been shown to be 20 to 40% heritable. A major prior collaborative study (EchoGen) relied on echocardiography measurement of LVH. We report here the results of the first genome-wide association study of an ECG index of LVH, the Cornell voltage, in a large US, population-based cohort. The Kaiser Permanente/UCSF Genetic Epidemiology Research on Adult Health and Aging (GERA) Cohort enrolled 110,266 persons, of whom 84,760 (77%) were of European ancestry (EA). Twelve-lead ECGs (obtained as part of routine medical care) were available in 59% (n=52,423; 62% female, mean age ± SD, 62 ± 13 years) of EA members of the GERA cohort. For those with more than 1 ECG (75%), one was selected at random. We programmatically derived from the digital tracings the Cornell voltage as R in aVL plus S in V3 (in mV). Mean ± SD Cornell voltages were 1.39 ± 0.58 mV in men and 1.16 ± 0.55 mV in women. Genotypes were generated on 674,518 SNPs using a custom designed Affymetrix Axiom array, and imputation was conducted using the 1000 Genomes data as a reference set. We identified 10 genetic loci (nearest genes: NFIA, CRIM1, CCDC141, HAND1, VGLL2, CTNNA, TBX3, SIPA1L1, ZNF595, and PROCR) with genome-wide significant associations (p<5*10 -8 ) with Cornell voltage as a continuous variable. Five of the loci (NFIA, CRIM1, HAND1, TBX3, and SIPA1L1) have previously been reported to influence QRS and PR intervals, while the other loci are novel. Interestingly, none of these loci were associated with left ventricular mass in the EchoGen consortium. Sex-specific analyses supported the association of these loci in both men and women; six loci were associated at a genome-wide significant level in these stratified analyses, including TBX3 and ZNF595 in both men and women, CCDC141, SIPA1L1, and PROCR in men, and VGLL2 in women, despite reduced sample sizes. These results may help elucidate both the biological and genetic basis of this clinically relevant phenotype.

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