Copyright
©The Author(s) 2019.
World J Cardiol. Mar 26, 2019; 11(3): 94-102
Published online Mar 26, 2019. doi: 10.4330/wjc.v11.i3.94
Published online Mar 26, 2019. doi: 10.4330/wjc.v11.i3.94
Table 1 Patient characteristics
Characteristic - no. (%) unless noted | Derivation cohort (n = 5486) | Validation cohort (n = 910) |
Age (mean ± SD) | 59.1 ± 15.8 | 58.6 ± 15.2 |
18-29 | 265 (4.8) | 30 (3.3) |
30-39 | 408 (7.4) | 91 (10.0) |
40-49 | 708 (12.9) | 105 (11.5) |
50-59 | 1295 (23.6) | 224 (24.6) |
60-69 | 1358 (24.8) | 242 (26.6) |
70 + | 1452 (26.5) | 218 (24.0) |
Male sex | 2869 (52.3) | 448 (49.2) |
Body mass index | ||
mean ± SD | 28.0 ± 6.6 | 28.5 ± 6.5 |
Median (range) | 26.9 (12.9-75.2) | 27.5 (15.8-66.1) |
Left ventricular mass by echocardiogram | ||
mean ± SD | 167.2 ± 62.1 | 173.3 ± 64.8 |
Median (intraquartile range) | 155.4 (123.3-200.4) | 163.0 (124.1-205.0) |
Left ventricular hypertrophy present by echocardiogram | 333 (6.1) | 80 (8.6) |
Time between echocardiogram and electrocardiogram in days (mean, intraquartile range) | 6.7 (0-13) | 5.9 (0-11) |
Table 2 Multivariate logistic regression analysis for left ventricular hypertrophy
Characteristic | Wald Chi-Square | P value |
Q-wave amplitude in V3 | 19.3 | P < 0.0001 |
R-wave amplitude in V6 | 39.7 | P < 0.0001 |
S-wave amplitude in V3 | 135 | P < 0.0001 |
QRS Duration | 115.4 | P < 0.0001 |
Discordant R-axis and T-axis (difference ≤ 75 or > 75) | 14.6 | P = 0.0001 |
Maximum (positive deflection) T-wave amplitude in V6 | 38.5 | P < 0.0001 |
Maximum P'-wave amplitude in V1 | 18.5 | P < 0.0001 |
P-wave peak amplitude in V6 | 0.19 | P = 0.659 |
Weight | 0.008 | P = 0.927 |
Height | 25.2 | P < 0.0001 |
Sex | 6.3 | P = 0.012 |
Age | 0.03 | P = 0.864 |
Table 3 Components of the electrocardiographic diagnostic score for left ventricular hypertrophy
Criteria | Number of points |
Sum of R-wave amplitude in V6 + S-wave amplitude in V3 + Q-wave amplitude in V3 > 4.0 mV in males and 3.2 mV in females | 1 |
QRS duration > 100 ms | 1 |
Absence of positive component of T-wave in V6 (maximum T-wave amplitude < 0) when overall QRS vector in V6 positive (i.e., R-wave larger than S-wave) | 1 |
Discordant limb lead R- and T-wave axis (R- minus T-wave axis ≤ 75 or > 75 degrees) | 0.5 |
Amplitude of negative terminal p-wave deflection in V1 greater than amplitude of positive deflection | 0.5 |
Table 4 Multivariate logistic regression analysis for left ventricular hypertrophy stratified by sex
Male (n = 2869) | Female (n = 2617) | |||
Characteristic | Wald Chi-Square | P value | Wald Chi-Square | P value |
Q-wave amplitude in V3 | 14.7 | P = 0.0001 | 5.0 | P = 0.025 |
R-wave amplitude in V6 | 25.5 | P < 0.0001 | 10.0 | P = 0.001 |
S-wave amplitude in V3 | 77.0 | p < 0.0001 | 53.6 | P < 0.0001 |
QRS Duration | 62.2 | P < 0.0001 | 51.2 | P < 0.0001 |
Discordant R-axis and T-axis (difference ≤ 75 or > 75) | 17.8 | p < 0.0001 | 0.63 | P = 0.426 |
Maximum (positive deflection) T-wave amplitude in V6 | 16.0 | P < 0.0001 | 26.1 | P < 0.0001 |
Maximum P'-wave amplitude in V1 | 9.4 | P = 0.002 | 4.6 | P = 0.031 |
P-wave peak amplitude in V6 | 1.0 | P = 0.314 | 3.5 | P = 0.061 |
Weight | 0.50 | P = 0.477 | 0.9 | P = 0.340 |
Height | 6.8 | P = 0.009 | 21.8 | P < 0.0001 |
Age | 1.4 | P = 0.245 | 1.06 | P = 0.303 |
Table 5 Sensitivity, specificity, and positive and negative predictive values of selected electrocardiographic criteria for left ventricular hypertrophy
Derivation cohort | Validation cohort | ||||||
Criteria | Cutoff | Sensitivity (95% CI) | Specificity (95% CI) | PPV | NPV | Sensitivity | Specificity |
Derived Criteria | 1.5 points | 67.9 (62.6-72.9) | 81.4 (80.3-82.4) | 19.0 | 97.5 | 62.5 | 83.2 |
"" | 2 points | 42.3 (37.0-47.7) | 93.0 (92.3-93.7) | 28.2 | 96.2 | 37.5 | 93.4 |
"" | 2.5 points | 30.0 (25.2-35.3) | 96.6 (96.1-97.1) | 37.6 | 95.6 | 30.0 | 96.8 |
Cornell | - | 37.8 (32.6-43.1) | 92.3 (91.6-93.0) | 24.1 | 95.8 | 36.2 | 90.3 |
Sokolow-Lyon | - | 16.5 (12.5-20.5) | 95.9 (95.4-96.5) | 20.7 | 94.7 | 20.0 | 96.3 |
Cornell Product | 55.0 (49.6-60.3) | 88.3 (87.5-89.2) | 23.3 | 96.8 | 53.8 | 88.1 | |
Sokolow-Lyon Product | 22.5 (18.0-27.0) | 95.9 (95.3-96.4) | 26.0 | 95.0 | 23.8 | 95.6 | |
Gubner-Ungerleider | 27.0 (22.3-31.8) | 88.9 (88.0-89.8) | 13.6 | 95.0 | 27.5 | 87.7 | |
Sum-of-12-Lead | 57.4 (51.9-62.7) | 76.1 (74.9-77.3) | 13.4 | 96.5 | 57.5 | 77.1 | |
Romhilt-Estes | 5 points | 35.4 (30.3-40.8) | 94.4 (93.7-95.0) | 26.2 | 95.8 | 35.0 | 95.0 |
"" | 4 points | 51.1 (45.5-56.5) | 88.2 (87.3-89.0) | 21.8 | 96.5 | 57.5 | 90.0 |
Framingham-adjusted Cornell | 42.3 (37.0-47.7) | 90.1 (89.3-90.9) | 21.7 | 96.0 | 51.3 | 87.6 | |
R-wave amplitude in aVL | 1.1 mV | 20.1 (16.0-24.8) | 92.6 (91.8-93.3) | 14.9 | 94.7 | 21.3 | 92.1 |
Peguero-Lo Presti | 24.9 (20.3-29.6) | 94.7 (94.1-95.3) | 23.3 | 95.1 | 26.3 | 93.5 |
- Citation: Braunstein ED, Croft LB, Halperin JL, Liao SL. Improved scoring system for the electrocardiographic diagnosis of left ventricular hypertrophy. World J Cardiol 2019; 11(3): 94-102
- URL: https://www.wjgnet.com/1949-8462/full/v11/i3/94.htm
- DOI: https://dx.doi.org/10.4330/wjc.v11.i3.94