What is the clinical evidence from this study?

Study design: Cohort. Population: Left ventricular hypertrophy (n=927). Intervention: Electrocardiographic voltage criteria vs. Echocardiographic left ventricular mass. Primary outcome: Detection of variations of left ventricular mass over time.

February 23, 2023Open Access

Comparison of electrocardiographic versus echocardiographic detection of left ventricular mass changes over time and evaluation of new onset left ventricular hypertrophy

Key Result

Electrocardiographic voltage criteria failed to accurately track left ventricular mass changes over 10 years compared to echocardiography, which detected a threefold increase in LVH prevalence.

Study Design

Type

Cohort (n=927)

Structured PICO

Do EKG voltage criteria accurately detect variations in left ventricular mass over time compared to echocardiography?

Population

927 subjects from the Pressioni Arteriose Monitorate E Loro Associazioni study, mean age 47 ± 13 years, 49.9% men.

Intervention

3 electrocardiographic (EKG) voltage criteria (Sokolow-Lyon voltage, Cornell voltage and R-wave voltage in aVL)

Comparator

Echocardiographic (ECHO) left ventricular mass (LVM) evaluation

Outcome

Detection of variations of left ventricular mass (LVM) over timesurrogate

EKG voltage criteria are unreliable for monitoring longitudinal changes in left ventricular mass compared to echocardiography.

Abstract

Abstract We assessed the value of 3 electrocardiographic (EKG) voltage criteria in detecting variations of left ventricular mass (LVM) over time, taking echocardiographic (ECHO) LVM as reference, in the Pressioni Arteriose Monitorate E Loro Associazioni study. In 927 subjects (age 47 ± 13 years on entry, 49.9% men) an ECHO evaluation of LVM and EKG suitable for measurement of EKG‐LVH criteria (Sokolow‐Lyon voltage, Cornell voltage and R‐wave voltage in aVL) were available at baseline and at a 2 nd evaluation performed 10 years later. Δ (delta) LVM, Δ LVMI, and Δ EKG parameters values were calculated from 2 nd evaluation to baseline. The sensitivity of the EKG criteria in the diagnosis of LVH, poor at baseline, becomes even worse after 10 years, reaching very low values. Only the sensitivity of R‐wave amplitude exhibited slight increase over time but with unsatisfactory absolute values. Despite the prevalence of ECHO‐LVH at the 2 nd evaluation was threefold increased compared to baseline (29.3% and 33.7% for LVM indexed to BSA and height 2.7 , respectively), the prevalence of EKG‐LVH was unchanged when evaluated by Sokolow‐Lyon criteria, significantly reduced when assessed by Cornell voltage index, while significantly increased using R‐wave voltage in aVL criteria. Despite an ECHO‐LVM increase over the time, mean EKG changes were of opposite sign, except for R‐wave amplitude in aVL. Our study highlights the discrepancy between ECHO and EKG in monitoring LVM changes over the time, especially for Sokolow‐Lyon and Cornell voltage. Thus, EKG is an unsuitable method for the longitudinal evaluation of LVM variations.