The Romhilt-Estes score was the most sensitive ECG criterion (75%) for detecting left ventricular hypertrophy in HCM patients and correlated with left ventricular mass index (r=0.41, p<0.0001).
Cross-Sectional (n=181)
Do specific 12-lead ECG parameters accurately predict left ventricular hypertrophy and myocardial fibrosis compared to CMR in patients with hypertrophic cardiomyopathy?
The Romhilt-Estes score is the most sensitive ECG criterion for detecting left ventricular hypertrophy in HCM patients because it is unaffected by myocardial fibrosis, whereas fragmented QRS and strain patterns are predictive of fibrosis.
Effect estimate: r = 0.41
p-value: p=<.0001
BACKGROUND: Structural myocardial changes in hypertrophic cardiomyopathy (HCM) are associated with different abnormalities on electrocardiographs (ECGs). The diagnostic value of the ECG voltage criteria used to screen for left ventricular hypertrophy (LVH) may depend on the presence and degree of myocardial fibrosis. Fibrosis can cause other changes in ECG parameters, such as pathological Q waves, fragmented QRS (fQRS), or repolarization abnormalities. METHODS: We investigated 146 patients with HCM and 35 healthy individuals who underwent cardiac magnetic resonance imaging (CMR; with late gadolinium enhancement LGE in HCM patients) and standard 12-lead ECGs. On the ECG, depolarization and repolarization abnormalities, the Sokolow-Lyon index, the Cornell index, and the Romhilt-Estes score were evaluated. The left ventricular ejection fraction, volumes, and myocardial mass (LVM) were quantified. Myocardial fibrosis was quantified on LGE images. RESULTS: The sensitivity of the Romhilt-Estes score was the highest (75%), and this hypertrophy criterion had the strongest correlation with the LVM index (p < .0001; r = .41). The amount of fibrosis was negatively correlated with the Cornell index (p = .015; r = -.201) and the Sokolow-Lyon index (p = .005; r = -.23), and the Romhilt-Estes score was independent of fibrosis (p = .757; r = 0.026). fQRS and strain pattern predicted more fibrosis, while the Cornell index was a negative predictor of myocardial fibrosis (p < .0001). Among others, the strain pattern was an independent predictor of the LVM (p < .0001). CONCLUSION: The Romhilt-Estes score is the most sensitive ECG criterion for detecting LVH in HCM patients, as myocardial fibrosis does not affect this criterion. The presence of fQRS and strain pattern predicts myocardial fibrosis.
Dohy et al. (Thu,) conducted a cross-sectional in Hypertrophic cardiomyopathy (n=181). ECG parameters (Romhilt-Estes score, Cornell index, Sokolow-Lyon index) vs. Healthy individuals was evaluated on Correlation of the Romhilt-Estes score with left ventricular mass index (r = 0.41, p=<.0001). The Romhilt-Estes score was the most sensitive ECG criterion (75%) for detecting left ventricular hypertrophy in HCM patients and correlated with left ventricular mass index (r=0.41, p<0.0001).