Sex Differences in the Relationships Between Electrocardiographic Abnormalities and the Extent of Left Ventricular Hypertrophy by Echocardiography

BACKGROUND: Several criteria have been proposed for the electrocardiographic diagnosis of left ventricular hypertrophy (LVH). However, their diagnostic accuracy is questionable. Furthermore, the diagnostic accuracy of abnormalities in ST-T patterns for LVH is known to be uncertain, especially in women. We examined the relationship between electrocardiographic abnormalities and the extent of LVH. METHODS: We studied 76 men and 48 women who satisfied electrocardiographic voltage criteria for LVH (RV(5) or RV(6)> or = 2.6 mV, SV(1) + RV(5) or SV(1) + RV(6)> or = 3.5 mV). They were classified into three groups based on ST-T pattern: normal, early strain, and strain. We defined echocardiographic evidence of LVH as an LV wall thickness > or = 12 mm. RESULTS: LVH was identified by echocardiography in 55.3% of men and in 47.9% of women. In strain and early strain groups, the prevalence of echocardiographic LVH was significantly higher in men than in women (strain group: 100 vs 75%, P < 0.05, early strain group: 81.8 vs 42.1%, P < 0.05), it did not differ significantly between men and women in normal group. In men, QRS voltage values were significantly correlated with echocardiographic indices. In group strain of men, significant good correlations were observed between QRS voltage values and echocardiographic indices. However, in women, there were no significant correlation between QRS voltage values and echocardiographic indices even in strain group. CONCLUSIONS: The combined criteria of both QRS voltage and ST-T classification could provide a greater accuracy in diagnosing LVH compared to the criteria using QRS voltage alone in men rather than in women.