Key result
Standard AHA ECG criteria show poor sensitivity and a maximum PPV of ~12% for RVH.
Why the study?
Current electrocardiographic criteria for right ventricular hypertrophy were based on cadaveric dissection in small studies.
Do the 2009 AHA surface ECG criteria accurately detect cMRI-defined right ventricular hypertrophy in adults without clinical cardiovascular disease?
Cohort (n=4,062)
Blinded image rereads
Yes
Do the 2009 AHA surface ECG criteria accurately detect cMRI-defined right ventricular hypertrophy in adults without clinical cardiovascular disease?
Standard 2009 AHA surface ECG criteria have poor sensitivity and positive predictive value (<=12%) for detecting mild RVH on cMRI and should not be used to screen asymptomatic adults without known cardiovascular disease.
Answers are grounded in this paper and cite their sources.
ECG criteria lack screening utility for mild RVH in asymptomatic adults; leaves open need for better noninvasive markers in population cohorts.
OBJECTIVES: The study aimed to assess the diagnostic properties of electrocardiographic (ECG) criteria for right ventricular hypertrophy (RVH) measured by cardiac magnetic resonance imaging (cMRI) in adults without clinical cardiovascular disease. BACKGROUND: Current ECG criteria for RVH were based on cadaveric dissection in small studies. METHODS: MESA (Multi-Ethnic Study of Atherosclerosis) performed cMRIs with complete right ventricle (RV) interpretation on 4,062 participants without clinical cardiovascular disease. Endocardial margins of the RV were manually contoured on diastolic and systolic images. The ECG screening criteria for RVH from the 2009 American Heart Association Recommendations for Standardization and Interpretation of the ECG were examined in participants with and without left ventricular (LV) hypertrophy or reduced ejection fraction. RVH was defined using sex-specific normative equations based on age, height, and weight. RESULTS: The study sample with normal LV morphology and function (n = 3,719) was age 61.3 ± 10.0 years, 53.5% female, 39.6% Caucasian, 25.5% African American, 21.9% Hispanic, and 13.0% Asian. The mean body mass index was 27.9 ± 5.0 kg/m(2). A total of 6% had RVH, which was generally mild. Traditional ECG criteria were specific (many >95%) but had low sensitivity for RVH by cMRI. The positive predictive values were not sufficiently high as to be clinically useful (maximum 12%). The results did not differ based on age, sex, race, or smoking status, or with the inclusion of participants with abnormal LV mass or function. Classification and regression tree analysis revealed that no combination of ECG variables was better than the criteria used singly. CONCLUSIONS: The recommended ECG screening criteria for RVH are not sufficiently sensitive or specific for screening for mild RVH in adults without clinical cardiovascular disease.
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Whitman et al. (2013) conducted a cohort in Right ventricular hypertrophy (RVH) in adults without clinical cardiovascular disease (n=4,062). 2009 AHA-recommended surface 12-lead ECG screening criteria for right ventricular hypertrophy vs. Cardiac magnetic resonance imaging (cMRI)-defined right ventricular hypertrophy (RV mass >95th percentile) was evaluated on Diagnostic accuracy (sensitivity, specificity, positive and negative predictive values) for cMRI-defined RVH in participants with normal LV morphology and function (95% CI 5.9-21.0). Traditional 2009 AHA ECG criteria had high specificity (>95%) but low sensitivity (<10% for most) and a maximum positive predictive value of 12% for detecting cMRI-defined RVH in asymptomatic adults.
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