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Miceli F, Presta V, Citoni B, Canichella F, Figliuzzi I, Ferrucci A, Volpe M, Tocci G. Conventional and new electrocardiographic criteria for hypertension-mediated cardiac organ damage: A narrative review. J Clin Hypertens (Greenwich) 2019; 21:1863-1871. [PMID: 31693279 DOI: 10.1111/jch.13726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/25/2019] [Accepted: 10/07/2019] [Indexed: 01/24/2023]
Abstract
Hypertension-mediated organ damage (HMOD) is frequently observed in hypertensive patients at different cardiovascular (CV) risk profile. This may have both diagnostic and therapeutic implications for the choice of the most appropriate therapies. Among different markers of HMOD, the most frequent functional and structural adaptations can be observed at cardiac level, including left ventricular hypertrophy (LVH), diastolic dysfunction, aortic root dilatation, and left atrial enlargement. In particular, LVH was shown to be a strong and independent risk factor for major CV events, namely myocardial infarction, stroke, congestive heart failure, CV death. Thus, early identification of LVH is a key element for preventing CV events in hypertension. Although echocardiographic assessment of LVH represents the gold standard technique, this is not cost-effective and cannot be adopted in routine clinical practice of hypertension. On the other hand, electrocardiographic (ECG) assessment of HMOD relative to the heart is a simple, reproducible, widely available and cost-effective method to assess the presence of LVH, and could be preferred in large scale screening tests. Several new indicators have been proposed and tested in observational studies and clinical trials of hypertension, in order to improve the relatively low sensitivity of the conventional ECG criteria for LVH, despite high specificity. This article reviews the differences in the use of the main conventional and the new 12 lead ECG criteria of LVH for early assessment of asymptomatic, subclinical cardiac HMOD in a setting of clinical practice of hypertension.
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Affiliation(s)
- Francesca Miceli
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Vivianne Presta
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Barbara Citoni
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Flaminia Canichella
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Ilaria Figliuzzi
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Andrea Ferrucci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy.,IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy.,IRCCS Neuromed, Pozzilli, Isernia, Italy
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Paajanen H, Helanterä I, Kaartinen K, Nikus K, Eskola M, Groop PH, Koskinen P. Electrocardiographic changes before and after successful kidney transplantation and associations with cardiovascular and mortality outcomes. Clin Transplant 2018; 32:e13242. [PMID: 29573467 DOI: 10.1111/ctr.13242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Electrocardiographic (ECG) changes before and after kidney transplantation are not well-defined. Our aim was to describe the evolution of ECG in patients on dialysis before and after successful kidney transplantation and to explore the association between ECG findings and major cardiovascular (CV) events and mortality after kidney transplantation. PATIENTS AND METHODS Electrocardiographics were collected retrospectively 3 times: at entry to the transplantation waiting list, at transplantation, and 1 year after the transplantation from 212 kidney transplantation recipients. Altogether 19 ECG variables were analyzed. RESULTS Left ventricular hypertrophy was present in 10.2% by the Cornell voltage-duration product criteria and 10.7% by the Sokolow-Lyon voltage criteria before kidney transplantation. The presence of ST depression (OR 3.12, 95% CI 1.12 -8.7 and P = .03) at entry to the waiting list and Q wave at the time of transplantation (OR 3.28, 95% CI 1.06-10.10 and P = .04) were both independently associated with major CV events after the transplantation. In addition, the presence of Q wave at entry to the waiting list was a risk factor of premature death after the transplantation (OR 2.92, 95% CI 1.06-8.05 and P = .04). DISCUSSION Careful analysis of the ECG before transplantation can be used to estimate cardiovascular events and mortality risk after kidney transplantation.
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Affiliation(s)
- Hanna Paajanen
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum, Helsinki, Finland.,Diabetes and Obesity Research Program, Research Program's Unit, University of Helsinki, Helsinki, Finland
| | - Ilkka Helanterä
- Abdominal Center Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kati Kaartinen
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Markku Eskola
- Heart Center, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Per-Henrik Groop
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum, Helsinki, Finland.,Diabetes and Obesity Research Program, Research Program's Unit, University of Helsinki, Helsinki, Finland.,Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Petri Koskinen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Lu N, Zhu JX, Yang PX, Tan XR. Models for improved diagnosis of left ventricular hypertrophy based on conventional electrocardiographic criteria. BMC Cardiovasc Disord 2017; 17:217. [PMID: 28789616 PMCID: PMC5549337 DOI: 10.1186/s12872-017-0637-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 07/20/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Electrocardiogram (ECG) is commonly used clinically due to convenience, but its accuracy is insufficient for left ventricular hypertrophy (LVH) diagnosis. In this study, we attempted to improve diagnostic accuracy of LVH by establishing models with ECG parameters. METHODS Eighty hundred and twenty eight patients were recruited in the present study which were divided into groups according to gender, age and body mass index (BMI). The sensitivity, specificity, Youden index, positive predictive value, negative predictive value and accuracy were calculated using ultrasonic cardiogram criteria of LVH as the gold standard. Area under the curve was also calculated to assess the diagnostic accuracy of 22 conventional ECG criteria in different groups. Stepwise discriminant analyses were performed to establish models of ECG for LVH. RESULTS The diagnostic accuracy of ECG11 (S V2 + R V5,6) and ECG12 (S V1,2 + R V5,6) was significantly higher than the other 20 criteria, while ECG15 (R V5/R V6) was lowest. The ECG12 sensitivity for males was 52.5%, for <60 years old was 44.2%, and for BMI <25 kg/m2 was 46.2%,higher than for females (27.5%), for ≧60 years old (35.7%), and for BMI ≧25 kg/m2(27.6%), respectively. The difference between genders was the most obvious. Based on these observations, the following models for males and females were established:[Formula: see text]and[Formula: see text]respectively. The sensitivities of the two new models were 71.4% and 75.8%, significantly higher than the22 conventional ECG criteria. CONCLUSION Two models developed based on gender can be considered for use to investigate the preliminary assessment of the probability of LVH.
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Affiliation(s)
- Nan Lu
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041 China
| | - Jin-Xiu Zhu
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041 China
| | - Pei-Xuan Yang
- Health Management Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041 China
| | - Xue-Rui Tan
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041 China
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Prevention of electrocardiographic left ventricular remodeling by the angiotensin receptor blocker olmesartan in patients with type 2 diabetes. J Hypertens 2016; 32:2267-76; discussion 2276. [PMID: 25275251 DOI: 10.1097/hjh.0000000000000313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the ability of olmesartan (OLM) to prevent or delay left ventricular remodeling and hypertrophy in patients with type 2 diabetes. METHODS This prespecified ECG substudy of Randomised OlmesArtan and Diabetes MicroAlbuminuria Prevention (ROADMAP), which compared OLM with placebo, assessed the signs of left ventricular remodeling in patients with a 12-lead ECG at baseline and after at least 2 years. Cornell voltage QRS duration product (primary objective), Cornell voltage index and Sokolow-Lyon index were assessed. RESULTS In total, 9418 ECG recordings and 1513 patients from ROADMAP were analyzed (placebo, n = 736; OLM, n = 777). Quartiles defined by baseline Cornell voltage QRS duration product were assessed and the proportion of patients in the highest quartile (≥200 mVms) increased from 24.0 to 26.5% in the placebo group and decreased from 25.5 to 22.3% in the OLM group [odds ratio (OR) 0.598 (95% confidence interval [CI] 0.440-0.813); P = 0.0011]. The OR did not change after adjustment for baseline parameters. By the end of study, 38.7% of patients in the placebo group and 34.7% in the OLM group shifted from a lower to a higher quartile or remained in the highest quartile of Cornell voltage QRS duration product [OR 0.797 (95% CI 0.637-0.996); P = 0.0465]. This translated into a 20.3% risk reduction with OLM and suggested OLM attenuated the progression of left ventricular remodeling versus placebo. CONCLUSION OLM substantially delayed the development of left ventricular remodeling in type 2 diabetes. This effect was not explained by the differences in blood pressure control. Thus, OLM delayed the onset of microalbuminuria, as well as the ECG signs of cardiac structural adaptation in type 2 diabetes.
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Germano G. Electrocardiographic Signs of Left Ventricular Hypertrophy in Obese Patients: What Criteria Should be Used? High Blood Press Cardiovasc Prev 2014; 22:5-9. [DOI: 10.1007/s40292-014-0062-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 06/10/2014] [Indexed: 11/30/2022] Open
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Castaño Castrillón JJ, Giraldo Cardona JF, Meza Botero LM, Muñoz Henao J, Ramírez Arias A, Rojas Ceballos C, Vivas Giraldo JP, Zapata Marín C. Hallazgos electrocardiográficos en pacientes hipertensos del programa de vigilancia y control de la hipertensión arterial de ASSBASALUD ESE, Manizales, Colombia. REVISTA DE LA FACULTAD DE MEDICINA 2014. [DOI: 10.15446/revfacmed.v62n1.43738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Sharma A, Chatterjee S, Shetty VS, Lichstein E. Sensitivity and specificity of commonly used EKG criterion to assess left ventricular hypertrophy in centenarians. Int J Cardiol 2013; 168:3102-3. [DOI: 10.1016/j.ijcard.2013.04.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 04/06/2013] [Indexed: 10/26/2022]
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Relationship between electrocardiographic left ventricular hypertrophy criteria and vascular structure and function parameters in hypertensive patients. J Hum Hypertens 2013; 28:186-92. [PMID: 24048290 DOI: 10.1038/jhh.2013.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/08/2013] [Accepted: 08/16/2013] [Indexed: 11/08/2022]
Abstract
The objective of this study was to determine the electrocardiographic left ventricular hypertrophy (LVH) criterion that best correlated with vascular structure and function parameters in hypertensive patients. A cross-sectional study involving 347 hypertensive patients was performed. The mean age of the subjects was 54.9±11.8 years, and 61% were male. Electrocardiography was used to detect LVH based on the evaluation of 10 criteria, and we defined the voltage-duration product (VDP) complex criterion. The vascular structure was evaluated according to carotid intima-media thickness (C-IMT), and vascular function was evaluated according to pulse wave velocity (PWV), the ambulatory arterial stiffness index (AASI), the home arterial stiffness index, and the peripheral (PAIx) and central (CAIx) augmentation indices. LVH according to at least some electrocardiographic criteria was recorded in 29.10% of the patients (34.10% of females; 25.90% of males). The vascular structure and function parameters showed higher values in the hypertensive patients with LVH. The criterion most closely correlated with C-IMT was Lewis-VDP (r=0.257); with PWV and AASI, the criterion was the Framingham-adjusted Cornell voltage (r=0.228 and r=0.195, respectively); and with CAIx and PAIx, the criterion was Novacode (r=0.226 and r=0.277, respectively). In the multivariate analysis, the association of the vascular structure and function parameters, the VDP complex (multiple linear regression) and the presence of LVH (logistic regression) disappeared after adjusting for age, sex and antihypertensive drugs. The relationship between the electrocardiographic criteria used to detect LVH in hypertensive patients and the vascular structure and function parameters were fundamentally conditioned by age and antihypertensive drug treatment.
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Varis JP, Puukka PJ, Karanko HM, Jula AM. Risk assessment of echocardiographic left ventricular hypertrophy with electrocardiography, body mass index and blood pressure. Blood Press 2013; 23:39-46. [DOI: 10.3109/08037051.2013.803313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Juha P. Varis
- Department of Medicine, Turku University Hospital,
Turku, Finland
| | - Pauli J. Puukka
- National Institute for Health and Welfare, Department of Chronic Disease Prevention,
Turku, Finland
| | - Hannu M. Karanko
- National Institute for Health and Welfare, Department of Chronic Disease Prevention,
Turku, Finland
| | - Antti M. Jula
- National Institute for Health and Welfare, Department of Chronic Disease Prevention,
Turku, Finland
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Siasos G, Oikonomou E, Chrysohoou C, Tousoulis D, Panagiotakos D, Zaromitidou M, Zisimos K, Kokkou E, Marinos G, Papavassiliou AG, Pitsavos C, Stefanadis C. Consumption of a boiled Greek type of coffee is associated with improved endothelial function: The Ikaria Study. Vasc Med 2013; 18:55-62. [DOI: 10.1177/1358863x13480258] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The association of coffee consumption with cardiovascular disease remains controversial. Endothelial function is associated with cardiovascular risk. We examined the association between chronic coffee consumption and endothelium function in elderly inhabitants of the island of Ikaria. Methods: The analysis was conducted on 142 elderly subjects (aged 66–91 years) of the Ikaria Study. Endothelial function was evaluated by ultrasound measurement of flow-mediated dilation (FMD). Coffee consumption was evaluated based on a food frequency questionnaire and was categorized as ‘low’ (< 200 ml/day), ‘moderate’ (200–450 ml/day), or ‘high’ (> 450 ml/day). Results: From the subjects included in the study, 87% consumed a boiled Greek type of coffee. Moreover, 40% had a ‘low’, 48% a ‘moderate’ and 13% a ‘high’ daily coffee consumption. There was a linear increase in FMD according to coffee consumption (‘low’: 4.33 ± 2.51% vs ‘moderate’: 5.39 ± 3.09% vs ‘high’: 6.47 ± 2.72%; p = 0.032). Moreover, subjects consuming mainly a boiled Greek type of coffee had a significantly higher FMD compared with those consuming other types of coffee beverages ( p = 0.035). Conclusions: Chronic coffee consumption is associated with improved endothelial function in elderly subjects, providing a new connection between nutrition and vascular health.
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Affiliation(s)
- Gerasimos Siasos
- 1st Department of Cardiology, ‘Hippokration’ Hospital, University of Athens Medical School, Athens, Greece
- Department of Biological Chemistry, University of Athens Medical School, Athens, Greece
| | - Evangelos Oikonomou
- 1st Department of Cardiology, ‘Hippokration’ Hospital, University of Athens Medical School, Athens, Greece
| | - Christina Chrysohoou
- 1st Department of Cardiology, ‘Hippokration’ Hospital, University of Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, ‘Hippokration’ Hospital, University of Athens Medical School, Athens, Greece
| | - Demosthenes Panagiotakos
- 1st Department of Cardiology, ‘Hippokration’ Hospital, University of Athens Medical School, Athens, Greece
| | - Marina Zaromitidou
- 1st Department of Cardiology, ‘Hippokration’ Hospital, University of Athens Medical School, Athens, Greece
| | - Konstantinos Zisimos
- 1st Department of Cardiology, ‘Hippokration’ Hospital, University of Athens Medical School, Athens, Greece
| | - Eleni Kokkou
- 1st Department of Cardiology, ‘Hippokration’ Hospital, University of Athens Medical School, Athens, Greece
| | - Georgios Marinos
- 1st Department of Cardiology, ‘Hippokration’ Hospital, University of Athens Medical School, Athens, Greece
| | | | - Christos Pitsavos
- 1st Department of Cardiology, ‘Hippokration’ Hospital, University of Athens Medical School, Athens, Greece
| | - Christodoulos Stefanadis
- 1st Department of Cardiology, ‘Hippokration’ Hospital, University of Athens Medical School, Athens, Greece
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Aortic artery distensibility shows inverse correlation with heart rate variability in elderly non-hypertensive, cardiovascular disease-free individuals: the Ikaria Study. Heart Vessels 2012; 28:467-72. [DOI: 10.1007/s00380-012-0267-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 06/01/2012] [Indexed: 10/28/2022]
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Waller AH, Gardin JM. Does Cardiovascular Ultrasound Have a Role in Assessment of Cardiovascular Risk in Asymptomatic Persons? CURRENT CARDIOVASCULAR RISK REPORTS 2012. [DOI: 10.1007/s12170-012-0225-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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