Key result
The R wave in aVL lead (RaVL) was a robust index for detecting left ventricular hypertrophy, yielding an area under the curve of 0.729.
Why the study?
Does the R wave in aVL lead on ECG accurately detect left ventricular hypertrophy compared to cardiac MRI in patients with or without myocardial infarction?
Observational (n=501)
Does the R wave in aVL lead on ECG accurately detect left ventricular hypertrophy compared to cardiac MRI in patients with or without myocardial infarction?
The R wave in aVL lead is a highly specific but poorly sensitive marker for left ventricular hypertrophy, with a proposed threshold of 1.0 mV to establish LVH across various clinical conditions.
Answers are grounded in this paper and cite their sources.
RaVL offers high specificity but limited sensitivity for LVH on ECG; hypothesis-generating versus cardiac MRI across MI status.
BACKGROUND: In patients free from overt cardiac disease, R wave in aVL lead (RaVL) is strongly correlated with left ventricular mass index (LVMI) assessed by transthoracic echocardiography. The aim of the present study was to extend this finding to other settings (cardiomyopathy or conduction disorders), by comparing ECG criteria of left ventricular hypertrophy (LVH) to cardiac MRI (CMR). METHODS: In 501 patients, CMR and ECG were performed within a median-period of 5 days. CMR LVH cut-offs used were 83 g/m2 in men and 67 g/m2 in women. RESULTS: RaVL was independently correlated with LVMI in patients with or without myocardial infarction (MI) (N = 300 and N = 201, respectively). SV3 was independently correlated with LVMI and LV enlargement only in patients without MI. In the whole cohort, RaVL had area under receiver-operating characteristic curve of 0.729 (specificity 98.3%, sensitivity 19.6%, optimal cut-off 1.1 mV). The performance of RaVL was remarkable in women, in Caucasians, and in the presence of right bundle branch block. It decreased in case of MI. Overall, it is proposed that below 0.5 mV and above 1.0 mV, RaVL is sufficient to exclude or establish LVH. Between 0.5 and 1 mV, composite indices (Cornell voltage or product) should be used. Using this algorithm allowed classifying appropriately 85% of the patients. CONCLUSIONS: Our results showed that RaVL is a good index of LVH with a univocal threshold of 1.0 mV in various clinical conditions. SV3 may be combined to RaVL in some conditions, namely LV enlargement to increase its performance.
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Courand et al. (2015) conducted an observational in Left ventricular hypertrophy (n=501). R wave in aVL lead (RaVL) vs. Cardiac MRI (CMR) was evaluated on Left ventricular hypertrophy (LVH) (AUC 0.729). The R wave in aVL lead (RaVL) was a robust index for detecting left ventricular hypertrophy, yielding an area under the curve of 0.729.
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