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Taki H, Tuomilehto J, Zimmet P, Tamosiunas A, Kowlessur S, Magliano DJ, Shaw JE, Söderberg S, Nilsson U. Left ventricular hypertrophy: an ECG-based study of prevalence and risk factors in a multiethnic population. Open Heart 2023; 10:e002495. [PMID: 37935562 PMCID: PMC10632900 DOI: 10.1136/openhrt-2023-002495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is frequently seen in association with arterial hypertension and indicates poor prognosis. This study aimed to determine the prevalence of LVH and associated factors in a multiethnic population from Mauritius. METHODS Population-based health surveys were performed in 2009 and 2015 and included in total 8961 individuals aged 35-75 years with recorded 12-lead ECG. LVH was defined according to three criteria: Sokolow-Lyon, Cornell voltage and Cornell product. Data were collected about health and lifestyle behaviour. Anthropometry and blood pressure were measured. Fasting levels of blood lipids and glucose were determined, oral glucose tolerance test was performed in people without glucose-lowering medications. RESULTS The age-standardised prevalence of LVH was 9% (n=875) according to any of the three ECG criteria. Individuals with LVH were older, more likely to have hypertension, diabetes, known cardiovascular disease (CVD) and elevated levels of cholesterol and creatinine. Further, they were more likely to be of African descent (Creole) and have lower educational level. In a multivariable model, Creole (OR (95% CI)) (1.56 (1.33 to 1.83)), low educational level (1.49 (1.28 to 1.75)), hypertension (3.01 (2.55 to 3.56)), known CVD (1.42 (1.11 to 1.83)) and elevated creatinine (1.08 (1.03 to 1.14)) remained associated with LVH. Individuals with non-treated or uncontrolled hypertension had a higher risk for LVH (3.09 (95% CI 2.57 to 3.71) and 4.07 (95% CI 3.29 to 5.05), respectively), than individuals with well controlled hypertension or normotension. CONCLUSION LVH occurs more frequently in individuals with hypertension, as well as in individuals with African ancestry and/or low education level.
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Affiliation(s)
- Hina Taki
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jaakko Tuomilehto
- Public Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Paul Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Abdonas Tamosiunas
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Dianna J Magliano
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jonathan E Shaw
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Ulf Nilsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Ryu JS, Lee S, Chu Y, Ahn MS, Park YJ, Yang S. CoAt-Mixer: Self-attention deep learning framework for left ventricular hypertrophy using electrocardiography. PLoS One 2023; 18:e0286916. [PMID: 37289800 PMCID: PMC10249819 DOI: 10.1371/journal.pone.0286916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
Left ventricular hypertrophy is a significant independent risk factor for all-cause mortality and morbidity, and an accurate diagnosis at an early stage of heart change is clinically significant. Electrocardiography is the most convenient, economical, and non-invasive method for screening in primary care. However, the coincidence rate of the actual left ventricular hypertrophy and diagnostic findings was low, consequently increasing the interest in algorithms using big data and deep learning. We attempted to diagnose left ventricular hypertrophy using big data and deep learning algorithms, and aimed to confirm its diagnostic power according to the differences between males and females. This retrospective study used electrocardiographs obtained at Yonsei University Wonju Severance Christian Hospital, Wonju, Korea, from October 2010 to February 2020. Binary classification was performed for primary screening for left ventricular hypertrophy. Three datasets were used for the experiment: the male, female, and entire dataset. A cutoff for binary classification was defined as the meaningful as a screening test (<132 g/m2 vs. ≥132 g/m2, <109 g/m2 vs. ≥109 g/m2). Six types of input were used for the classification tasks. We attempted to determine whether electrocardiography had predictive power for left ventricular hypertrophy diagnosis. For the entire dataset, the model achieved an area under the receiver operating characteristic (AUROC) curve of 0.836 (95% CI, 0.833-838) with a sensitivity of 78.37% (95% CI, 76.79-79.95). For the male dataset, the AUROC was 0.826 (95% CI, 0.822-830) with a sensitivity of 76.73% (95% CI, 75.14-78.33). For the female dataset, the AUROC was 0.772 (95% CI, 0.769-775) with a sensitivity of 72.90% (95% CI, 70.33-75.46). Our model confirmed that left ventricular hypertrophy can be classified to some extent using electrocardiography, demographics, and electrocardiography features. In particular, a learning environment that considered gender differences was constructed. Consequently, the difference in diagnostic power between men and women was confirmed. Our model will help patients with suspected left ventricular hypertrophy to undergo screening tests at a low cost. In addition, our research and attempts will show the expected effect that gender-consideration approaches can help with various currently proposed diagnostic methods.
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Affiliation(s)
- Ji Seung Ryu
- Department of Precision Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Solam Lee
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yuseong Chu
- Department of Biomedical Engineering, Yonsei University, Wonju, Korea
| | - Min-Soo Ahn
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Jun Park
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sejung Yang
- Department of Precision Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Henry JA, Abdesselam I, Deal O, Lewis AJ, Rayner J, Bernard M, Dutour A, Gaborit B, Kober F, Soghomonian A, Sgromo B, Byrne J, Bege T, Neubauer S, Borlaug BA, Rider OJ. Changes in epicardial and visceral adipose tissue depots following bariatric surgery and their effect on cardiac geometry. Front Endocrinol (Lausanne) 2023; 14:1092777. [PMID: 36761185 PMCID: PMC9905224 DOI: 10.3389/fendo.2023.1092777] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023] Open
Abstract
Introduction Obesity affects cardiac geometry, causing both eccentric (due to increased cardiac output) and concentric (due to insulin resistance) remodelling. Following bariatric surgery, reversal of both processes should occur. Furthermore, epicardial adipose tissue loss following bariatric surgery may reduce pericardial restraint, allowing further chamber expansion. We investigated these changes in a serial imaging study of adipose depots and cardiac geometry following bariatric surgery. Methods 62 patients underwent cardiac magnetic resonance (CMR) before and after bariatric surgery, including 36 with short-term (median 212 days), 37 medium-term (median 428 days) and 32 long-term (median 1030 days) follow-up. CMR was used to assess cardiac geometry (left atrial volume (LAV) and left ventricular end-diastolic volume (LVEDV)), LV mass (LVM) and LV eccentricity index (LVei - a marker of pericardial restraint). Abdominal visceral (VAT) and epicardial (EAT) adipose tissue were also measured. Results Patients on average had lost 21kg (38.9% excess weight loss, EWL) at 212 days and 36kg (64.7% EWL) at 1030 days following bariatric surgery. Most VAT and EAT loss (43% and 14%, p<0.0001) occurred within the first 212 days, with non-significant reductions thereafter. In the short-term LVM (7.4%), LVEDV (8.6%) and LAV (13%) all decreased (all p<0.0001), with change in cardiac output correlated with LVEDV (r=0.35,p=0.03) and LAV change (r=0.37,p=0.03). Whereas LVM continued to decrease with time (12% decrease relative to baseline at 1030 days, p<0.0001), both LAV and LVEDV had returned to baseline by 1030 days. LV mass:volume ratio (a marker of concentric hypertrophy) reached its nadir at the longest timepoint (p<0.001). At baseline, LVei correlated with baseline EAT (r=0.37,p=0.0040), and decreased significantly from 1.09 at baseline to a low of 1.04 at 428 days (p<0.0001). Furthermore, change in EAT following bariatric surgery correlated with change in LVei (r=0.43,p=0.0007). Conclusions Cardiac volumes show a biphasic response to weight loss, initially becoming smaller and then returning to pre-operative sizes by 1030 days. We propose this is due to an initial reversal of eccentric remodelling followed by reversal of concentric remodelling. Furthermore, we provide evidence for a role of EAT contributing to pericardial restraint, with EAT loss improving markers of pericardial restraint.
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Affiliation(s)
- J. A. Henry
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - I. Abdesselam
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - O. Deal
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - A. J. Lewis
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - J. Rayner
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - M. Bernard
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
| | - A. Dutour
- Aix-Marseille Univ, APHM, INSERM, INRAE, C2VN, Department of Endocrinology, Metabolic Diseases and Nutrition, Marseille, France
| | - B. Gaborit
- Aix-Marseille Univ, APHM, INSERM, INRAE, C2VN, Department of Endocrinology, Metabolic Diseases and Nutrition, Marseille, France
| | - F. Kober
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
| | - A. Soghomonian
- Aix-Marseille Univ, APHM, INSERM, INRAE, C2VN, Department of Endocrinology, Metabolic Diseases and Nutrition, Marseille, France
| | - B. Sgromo
- Department of Upper GI Surgery, Churchill Hospital, Oxford, United Kingdom
| | - J. Byrne
- Division of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - T. Bege
- Aix-Marseille Univ, APHM, Department of Digestive Surgery, Hôpital Nord, Marseille, France
| | - S. Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - B. A. Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - O. J. Rider
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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Rochelson E, Howard TS, Kim JJ. Demystifying the Pediatric Electrocardiogram: Tools for the Practicing Pediatrician. Pediatr Rev 2023; 44:3-13. [PMID: 36587025 DOI: 10.1542/pir.2021-005346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Ellis Rochelson
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, NY
| | - Taylor S Howard
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Jeffrey J Kim
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
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Clinical applicability and diagnostic performance of electrocardiographic criteria for left ventricular hypertrophy diagnosis in older adults. Sci Rep 2021; 11:11516. [PMID: 34075174 PMCID: PMC8169892 DOI: 10.1038/s41598-021-91083-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/19/2021] [Indexed: 12/25/2022] Open
Abstract
Recently, a new ECG criterion, the Peguero-Lo Presti (PLP), improved overall accuracy in the diagnosis of left ventricular hypertrophy (LVH)—compared to traditional ECG criteria, but with few patients with advanced age. We analyzed patients with older age and examined which ECG criteria would have better overall performance. A total of 592 patients were included (83.1% with hypertension, mean age of 77.5 years) and the PLP criterion was compared against Cornell voltage (CV), Sokolow-Lyon voltage (SL) and Romhilt-Estes criteria (cutoffs of 4 and 5 points, RE4 and RE5, respectively) using LVH defined by the echocardiogram as the gold standard. The PLP had higher AUC than the CV, RE and SL (respectively, 0.70 vs 0.66 vs 0.64 vs 0.67), increased sensitivity compared with the SL, CV and RE5 (respectively, 51.9% [95% CI 45.4–58.3%] vs 28.2% [95% CI 22.6–34.4%], p < 0.0001; vs 35.3% [95% CI 29.2–41.7%], p < 0.0001; vs 44.4% [95% CI 38.0–50.9%], p = 0.042), highest F1 score (58.3%) and net benefit for most of the 20–60% threshold range in the decision curve analysis. Overall, despite the best diagnostic performance in older patients, the PLP criterion cannot rule out LVH consistently but can potentially be used to guide clinical decision for echocardiogram ordering in low-resource settings.
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Budkiewicz A, Surdacki MA, Gamrat A, Trojanowicz K, Surdacki A, Chyrchel B. Electrocardiographic Versus Echocardiographic Left Ventricular Hypertrophy in Severe Aortic Stenosis. J Clin Med 2021; 10:jcm10112362. [PMID: 34072214 PMCID: PMC8198672 DOI: 10.3390/jcm10112362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
Although ECG used to be a traditional method to detect left ventricular hypertrophy (LVH), its importance has decreased over the years and echocardiography has emerged as a routine technique to diagnose LVH. Intriguingly, an independent negative prognostic effect of the "electrical" LVH (i.e., by ECG voltage criteria) beyond echocardiographic LVH was demonstrated both in hypertension and aortic stenosis (AS), the most prevalent heart valve disorder. Our aim was to estimate associations of the ECG-LVH voltage criteria with echocardiographic LVH and indices of AS severity. We retrospectively manually analyzed ECG tracings of 50 patients hospitalized in our center for severe isolated aortic stenosis, including 32 subjects with echocardiographic LVH. The sensitivity of single traditional ECG-LVH criteria in detecting echocardiographic LVH was 9-34% and their respective specificity averaged 78-100%. The ability to predict echocardiographic LVH was higher for S-waves than R-waves (mean area under the receiver operating curve (AUC): 0.62-0.70 vs. 0.58-0.65). Among combinations of R- and S-waves, the discriminating ability was highest for the Cornell voltage (AUC: 0.71) compared to the Sokolow-Lyon, Romhilt and Gubner-Ungerleider voltage (AUC: 0.62-0.68). By multiple regression, peak aortic pressure gradient was positively related to the Sokolow-Lyon (β = 1.7 ± 0.5, p = 0.002) and Romhilt voltage (β = 1.3 ± 0.5, p = 0.01), but not Cornell (0.5 ± 0.3, p = 0.2) or Gubner-Ungerleider voltage (β = 0.0 ± 0.5, p > 0.9), regardless of LV mass index. In conclusion, echocardiographic LVH and stenosis severity appear to have distinct associations with traditional ECG-LVH criteria in AS. A moderate diagnostic superiority of the Cornell voltage criterion with regard to anatomic LVH might result from its unique ability to include depolarization vectors in both the frontal and horizontal plane with consequent lesser sensitivity to the confounding effect of obesity.
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Affiliation(s)
- Aleksandra Budkiewicz
- Students’ Scientific Group, Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (A.B.); (M.A.S.); (A.G.); (K.T.)
| | - Michał A. Surdacki
- Students’ Scientific Group, Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (A.B.); (M.A.S.); (A.G.); (K.T.)
| | - Aleksandra Gamrat
- Students’ Scientific Group, Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (A.B.); (M.A.S.); (A.G.); (K.T.)
| | - Katarzyna Trojanowicz
- Students’ Scientific Group, Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (A.B.); (M.A.S.); (A.G.); (K.T.)
| | - Andrzej Surdacki
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Jakubowskiego Street, 30-688 Cracow, Poland;
| | - Bernadeta Chyrchel
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Jakubowskiego Street, 30-688 Cracow, Poland;
- Correspondence: ; Tel.: +48-12-400-2250
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Bayram N, Akoğlu H, Sanri E, Karacabey S, Efeoğlu M, Onur O, Denizbasi A. Diagnostic Accuracy of the Electrocardiography Criteria for Left Ventricular Hypertrophy (Cornell Voltage Criteria, Sokolow-Lyon Index, Romhilt-Estes, and Peguero-Lo Presti Criteria) Compared to Transthoracic Echocardiography. Cureus 2021; 13:e13883. [PMID: 33868847 PMCID: PMC8043050 DOI: 10.7759/cureus.13883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective/Aim: We aimed to evaluate the diagnostic utility of the widely used left ventricular hypertrophy (LVH) electrocardiography (ECG) criteria (Cornell Voltage Criteria [CVC], Sokolow-Lyon Index [SLI], Romhilt-Estes [REC], and Peguero-Lo Presti [PLP] Criteria) compared with the left ventricular mass measured by echocardiography. Methods: In this prospective diagnostic accuracy study, we screened all consecutive adults (18 to 65 years) who presented to our academic emergency department (ED) with increased blood pressure (≥130/85 mmHg) between January 2016 and January 2017, and we enrolled a convenience sample of 165 patients in our study. The attending emergency physician managed all patients as per their primary complaint. The consulting cardiologist performed a transthoracic echocardiogram (TTE) of the patient and calculated the left ventricular mass (LVM) according to the American Society of Echocardiography (ASE) formula. After completing the patient recruitment phase, researchers evaluated all ECGs and calculated scores for SLI, CVC, REC, and PLP. We used contingency tables to calculate the diagnostic utility metrics of all ECG criteria. Results: The prevalence of LVH by TTE was 31.5%. CVC, SLI, REC, and PLP criteria correctly identified (true positive rate) abnormal LVM in only 3.9%, 1.9%, 9.6%, and 19.2% of the patients, respectively. CVC, SLI, REC score and PLP criteria performed poorly with extremely low sensitivities (3.9%, 1.9%, 10%, 19.2%) and poor accuracies (67.3%, 64.9%, 57.7%, 69.7%). Conclusion: ECG voltage criteria's clinical utility in estimating LVM and LVH is low, and it should not be used for this purpose.
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Affiliation(s)
- Nurseli Bayram
- Department of Emergency Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, TUR
| | - Haldun Akoğlu
- Department of Emergency Medicine, Marmara University School of Medicine, Istanbul, TUR
| | - Erkman Sanri
- Department of Emergency Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, TUR
| | - Sinan Karacabey
- Department of Emergency Medicine, Marmara University School of Medicine, Istanbul, TUR
| | - Melis Efeoğlu
- Department of Emergency Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, TUR
| | - Ozge Onur
- Department of Emergency Medicine, Marmara University School of Medicine, Istanbul, TUR
| | - Arzu Denizbasi
- Department of Emergency Medicine, Marmara University School of Medicine, Istanbul, TUR
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Zareba KM, Truong VT, Mazur W, Smart SM, Xia X, Couderc JP, Raman SV. T-wave and its association with myocardial fibrosis on cardiovascular magnetic resonance examination. Ann Noninvasive Electrocardiol 2020; 26:e12819. [PMID: 33336876 PMCID: PMC7935103 DOI: 10.1111/anec.12819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/03/2020] [Accepted: 11/12/2020] [Indexed: 12/13/2022] Open
Abstract
Background Risk stratification in non‐ischemic myocardial disease poses a challenge. While cardiovascular magnetic resonance (CMR) is a comprehensive tool, the electrocardiogram (ECG) provides quick impactful clinical information. Studying the relationships between CMR and ECG can provide much‐needed risk stratification. We evaluated the electrocardiographic signature of myocardial fibrosis defined as presence of late gadolinium enhancement (LGE) or extracellular volume fraction (ECV) ≥29%. Methods We evaluated 240 consecutive patients (51% female, 47.1 ± 16.6 years) referred for a clinical CMR who underwent 12‐lead ECGs within 90 days. ECG parameters studied to determine association with myocardial fibrosis included heart rate, QRS amplitude/duration, T‐wave amplitude, corrected QT and QT peak, and Tpeak‐Tend. Abnormal T‐wave was defined as low T‐wave amplitude ≤200 µV or a negative T wave, both in leads II and V5. Results Of the 147 (61.3%) patients with myocardial fibrosis, 67 (28.2%) had ECV ≥ 29%, and 132 (54.6%) had non‐ischemic LGE. An abnormal T‐wave was more prevalent in patients with versus without myocardial fibrosis (66% versus 42%, p < .001). Multivariable analysis demonstrated that abnormal T‐wave (OR 1.95, 95% CI 1.09–3.49, p = .03) was associated with myocardial fibrosis (ECV ≥ 29% or LGE) after adjustment for clinical covariates (age, gender, history of hypertension, and heart failure). Dynamic nomogram for predicting myocardial fibrosis using clinical parameters and the T‐wave was developed: https://normogram.shinyapps.io/CMR_Fibrosis/. Conclusion Low T‐wave amplitude ≤ 200 µV or negative T‐waves are independently associated with myocardial fibrosis. Prospective evaluation of T‐wave amplitude may identify patients with a high probability of myocardial fibrosis and guide further indication for CMR.
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Affiliation(s)
- Karolina M Zareba
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vien T Truong
- Division of Cardiology, The Christ Hospital Health Network, Cincinnati, OH, USA
| | - Wojciech Mazur
- Division of Cardiology, The Christ Hospital Health Network, Cincinnati, OH, USA
| | - Suzanne M Smart
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Xiaojuan Xia
- Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Jean-Philippe Couderc
- Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Subha V Raman
- Division of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
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Afify H, Lee HL, Soliman EZ, Singleton MJ. Prognostic significance of body mass index-adjusted criteria for left ventricular hypertrophy. J Clin Hypertens (Greenwich) 2020; 22:1476-1483. [PMID: 32762125 DOI: 10.1111/jch.13973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 01/19/2023]
Abstract
Electrocardiographic left ventricular hypertrophy (ECG-LVH) is associated with both cardiovascular and all-cause mortality. Obesity attenuates the sensitivity of several ECG-LVH criteria, so body mass index (BMI) adjusted criteria have been developed. However, the prognostic significance of BMI-adjusted ECG-LVH criteria is not known. This analysis included 7812 participants (59.8 ± 13.4 years, 53% women, 50% non-Hispanic-whites) from the Third National Health and Nutrition Examination Survey. The Cornell criteria (R in aVL + S in V3 ≥ 2800 µV in men or ≥2200 µV in women) and Sokolow-Lyon criteria (S in V1 + R in V5 or R in V6 ≥ 3500 µV) criteria were used for LVH. To account for the effects of obesity, the BMI-adjusted Cornell criteria (product of R in aVL + S in V3 and BMI > 60 400 µV kg m-2 ) and the BMI-adjusted Sokolow-Lyon criteria (add 400 µV if overweight, add 800 µV if obese) were used. Compared to traditional ECG-LVH criteria, more participants met criteria for ECG-LVH with BMI-adjusted Cornell voltage (9.9% vs 2.9%) and BMI-adjusted Sokolow-Lyon (13.1% vs 6.4%) criteria. In multivariable-adjusted Cox proportional hazards models, the BMI-adjusted Sokolow-Lyon criteria performed no better than traditional criteria (HR 1.18, 95% CI 1.06-1.32 for all-cause, HR 1.38, 95% CI 1.17-1.62 for cardiovascular mortality) and the BMI-adjusted Cornell voltage criteria attenuated the association with all-cause (HR 1.16, 95% CI 1.03-1.32) and cardiovascular mortality (HR 1.34, 95% CI 1.13-1.60). Despite potential improvements in the detection of LVH using BMI-adjusted ECG-LVH criteria, adjusting for BMI may result in the loss of prognostic information.
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Affiliation(s)
- Hesham Afify
- Department of Medicine, University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Ho Lim Lee
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Matthew J Singleton
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Noubiap JJ, Agbaedeng TA, Nyaga UF, Nkoke C, Jingi AM. A meta-analytic evaluation of the diagnostic accuracy of the electrocardiographic Peguero-Lo Presti criterion for left ventricular hypertrophy. J Clin Hypertens (Greenwich) 2020; 22:1145-1153. [PMID: 32608577 DOI: 10.1111/jch.13923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/01/2020] [Accepted: 06/06/2020] [Indexed: 12/15/2022]
Abstract
Although electrocardiography (ECG) is a cost-effective and convenient tool for routine screening of left ventricular hypertrophy (LVH), its performance has been shown to be poor. The Peguero-Lo Presti, a novel voltage criterion, was found to be potentially better than the most commonly used criteria. We conducted a systematic review and meta-analysis of its diagnostic accuracy compared to Cornell and Sokolow-Lyon voltage criteria. Bibliographic databases were searched to identify relevant articles. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (ROC) curves were performed for comparison. Ten studies reporting data from 5984 individuals were included in the meta-analysis. Peguero-Lo Presti had the highest pooled sensitivity (43.0%, 95% confidence interval [CI]: 30.2-56.9) followed by Cornell (26.1%; 95% CI: 16.9-37.9) and Sokolow Lyon (22.0%; 95% CI: 14.1-32.7). However, Peguero-Lo Presti had the lesser pooled specificity (90.5%; 95% CI: 86.3-93.5) and Cornell the highest (94.9%; 95% CI: 90.3-97.3). The pooled DOR was 6.63 (95% CI: 3.95-11.13), 5.50 (95% CI: 3.64-8.30), and 2.94 (95% CI: 2.20-3.92) for Peguero-Lo Presti, Cornell, and Sokolow-Lyon, respectively. Peguero-Lo Presti had the best accuracy according to summary ROC curves, with an area under the curve of 0.827 compared to 0.715 for Cornell, and 0.623 for Sokolow-Lyon. In conclusion, according to this meta-analysis, Peguero-Lo Presti has a better diagnostic performance than Cornell and Sokolow-Lyon and might be more useful in routine clinical practice as a screening tool for LVH.
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Affiliation(s)
- Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Thomas A Agbaedeng
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Ulrich Flore Nyaga
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
| | - Clovis Nkoke
- Division of Cardiology, Buea Regional Hospital, Buea, Cameroon
| | - Ahmadou M Jingi
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
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12
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Lewis AJM, Rider OJ. The use of cardiovascular magnetic resonance for the assessment of left ventricular hypertrophy. Cardiovasc Diagn Ther 2020; 10:568-582. [PMID: 32695638 DOI: 10.21037/cdt.2020.01.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Cardiovascular magnetic resonance (CMR) is a powerful tool to assess and diagnose the cause of left ventricular hypertrophy (LVH). This review provides an overview of the typical CMR findings in the various causes of LVH, focusing mainly on late gadolinium enhancement (LGE) imaging. It will also cover the more novel techniques of T1 mapping, extracellular volume (ECV) fraction estimation and diffusion tensor imaging (DTI) and their role in the imaging assessment of LVH.
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Affiliation(s)
- Andrew J M Lewis
- Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, Oxford, UK
| | - Oliver J Rider
- Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, Oxford, UK
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Ojji D, Libhaber E, Lamont K, Thienemann F, Sliwa K. Circulating biomarkers in the early detection of hypertensive heart disease: usefulness in the developing world. Cardiovasc Diagn Ther 2020; 10:296-304. [PMID: 32420112 DOI: 10.21037/cdt.2019.09.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Although the varying phenotypic spectra of hypertensive heart disease (HHD) can be assessed by electrocardiography (ECG), echocardiography and cardiovascular magnetic resonance (CMR), ECG criteria for left ventricular hypertrophy (LVH) are insensitive, while echocardiography and CMR are expensive, less readily available and often lack requisite expertise. Consequently, the use of circulating biomarkers in the diagnosis and prognostication of HHD beyond the traditional N-terminal pro- b-type natriuretic peptide (NT-proBNP) and B-type natriuretic peptide (BNP) have become an attractive alternative. We carried out a PubMed and Google Scholar databases' search of original articles on circulating biomarkers used in the diagnosis of the different spectrum of HHD over the last 10 years [2005-2015] in humans. Fourteen studies met the inclusion criteria with NT-pro BNP being the most studied circulating biomarker in HHD followed by soluble ST2 (sST2). There is a lack of data on the use of circulating biomarkers in HHD. There is a need to explore further this area of investigative cardiology.
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Affiliation(s)
- Dike Ojji
- Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Elena Libhaber
- Soweto Cardiovascular Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - Kim Lamont
- Soweto Cardiovascular Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - Friedrich Thienemann
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine and Cardiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Internal Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Karen Sliwa
- Soweto Cardiovascular Research Unit, University of Witwatersrand, Johannesburg, South Africa.,Hatter Institute for Cardiovascular Research in Africa, Department of Medicine and Cardiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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14
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Kashou AH, Noseworthy PA. Artificial intelligence capable of detecting left ventricular hypertrophy: pushing the limits of the electrocardiogram? Europace 2020; 22:338-339. [PMID: 31898741 DOI: 10.1093/europace/euz349] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anthony H Kashou
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Peter A Noseworthy
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Snelder SM, van de Poll SWE, de Groot-de Laat LE, Kardys I, Zijlstra F, van Dalen BM. Optimized electrocardiographic criteria for the detection of left ventricular hypertrophy in obesity patients. Clin Cardiol 2020; 43:483-490. [PMID: 31990994 PMCID: PMC7244296 DOI: 10.1002/clc.23333] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/16/2019] [Accepted: 12/28/2019] [Indexed: 12/17/2022] Open
Abstract
Background Despite a generally high specificity, electrocardiographic (ECG) criteria for the detection of left ventricular hypertrophy (LVH) lack sensitivity, particularly in obesity patients. Objectives The aim of the study was to evaluate the accuracy of the most commonly used ECG criteria (Cornell voltage and Sokolow‐Lyon index), the recently introduced Peguero‐Lo Presti criteria and the correction of these criteria by body mass index (BMI) to detect LVH in obesity patients and to propose adjusted ECG criteria with optimal accuracy. Methods The accuracy of the ECG criteria for the detection of LVH was retrospectively tested in a cohort of obesity patients referred for a transthoracic echocardiogram based on clinical grounds (test cohort, n = 167). Adjusted ECG criteria with optimal sensitivity for the detection of LVH were developed. Subsequently, the value of these criteria was prospectively tested in an obese population without known cardiovascular disease (validation cohort, n = 100). Results Established ECG criteria had a poor sensitivity in obesity patients in both the test cohort and the validation cohort. The adjusted criteria showed improved sensitivity, with optimal values for males using the Cornell voltage corrected for BMI, (RaVL+SV3)*BMI ≥700 mm*kg/m2; sensitivity 47% test cohort, 40% validation cohort; for females, the Sokolow‐Lyon index corrected for BMI, (SV1 + RV5/RV6)*BMI ≥885 mm*kg/m2; sensitivity 26% test cohort, 23% validation cohort. Conclusions Established ECG criteria for the detection of LVH lack sufficient sensitivity in obesity patients. We propose new criteria for the detection of LVH in obesity patients with improved sensitivity, approaching known sensitivity of the most commonly used ECG criteria in lean subjects.
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Affiliation(s)
- Sanne M Snelder
- Department of Cardiology, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | | | | | - Isabella Kardys
- Department of Cardiology, Thoraxcenter, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands
| | - Bas M van Dalen
- Department of Cardiology, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands.,Department of Cardiology, Thoraxcenter, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands
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Kwon JM, Jeon KH, Kim HM, Kim MJ, Lim SM, Kim KH, Song PS, Park J, Choi RK, Oh BH. Comparing the performance of artificial intelligence and conventional diagnosis criteria for detecting left ventricular hypertrophy using electrocardiography. Europace 2019; 22:412-419. [DOI: 10.1093/europace/euz324] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/05/2019] [Indexed: 01/12/2023] Open
Abstract
Abstract
Aims
Although left ventricular hypertrophy (LVH) has a high incidence and clinical importance, the conventional diagnosis criteria for detecting LVH using electrocardiography (ECG) has not been satisfied. We aimed to develop an artificial intelligence (AI) algorithm for detecting LVH.
Methods and results
This retrospective cohort study involved the review of 21 286 patients who were admitted to two hospitals between October 2016 and July 2018 and underwent 12-lead ECG and echocardiography within 4 weeks. The patients in one hospital were divided into a derivation and internal validation dataset, while the patients in the other hospital were included in only an external validation dataset. An AI algorithm based on an ensemble neural network (ENN) combining convolutional and deep neural network was developed using the derivation dataset. And we visualized the ECG area that the AI algorithm used to make the decision. The area under the receiver operating characteristic curve of the AI algorithm based on ENN was 0.880 (95% confidence interval 0.877–0.883) and 0.868 (0.865–0.871) during the internal and external validations. These results significantly outperformed the cardiologist’s clinical assessment with Romhilt-Estes point system and Cornell voltage criteria, Sokolov-Lyon criteria, and interpretation of ECG machine. At the same specificity, the AI algorithm based on ENN achieved 159.9%, 177.7%, and 143.8% higher sensitivities than those of the cardiologist’s assessment, Sokolov-Lyon criteria, and interpretation of ECG machine.
Conclusion
An AI algorithm based on ENN was highly able to detect LVH and outperformed cardiologists, conventional methods, and other machine learning techniques.
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Affiliation(s)
- Joon-Myoung Kwon
- Department of Emergency Medicine, Mediplex Sejong Hospital, 20, Gyeyangmunhwa-ro, Gyeyang-gu, Incheon, Republic of Korea
- Artificial Intelligence and Big Data Research Center, Sejong Medical Research Institute, 28, Hohyeon-ro 489beon-gil, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Ki-Hyun Jeon
- Artificial Intelligence and Big Data Research Center, Sejong Medical Research Institute, 28, Hohyeon-ro 489beon-gil, Bucheon-si, Gyeonggi-do, Republic of Korea
- Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, 20, Gyeyangmunhwa-ro, Gyeyang-gu, 21080 Incheon, Republic of Korea
| | - Hyue Mee Kim
- Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, 20, Gyeyangmunhwa-ro, Gyeyang-gu, 21080 Incheon, Republic of Korea
| | - Min Jeong Kim
- Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, 20, Gyeyangmunhwa-ro, Gyeyang-gu, 21080 Incheon, Republic of Korea
| | - Sung Min Lim
- Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, 20, Gyeyangmunhwa-ro, Gyeyang-gu, 21080 Incheon, Republic of Korea
| | - Kyung-Hee Kim
- Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, 20, Gyeyangmunhwa-ro, Gyeyang-gu, 21080 Incheon, Republic of Korea
| | - Pil Sang Song
- Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, 20, Gyeyangmunhwa-ro, Gyeyang-gu, 21080 Incheon, Republic of Korea
| | - Jinsik Park
- Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, 20, Gyeyangmunhwa-ro, Gyeyang-gu, 21080 Incheon, Republic of Korea
| | - Rak Kyeong Choi
- Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, 20, Gyeyangmunhwa-ro, Gyeyang-gu, 21080 Incheon, Republic of Korea
| | - Byung-Hee Oh
- Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, 20, Gyeyangmunhwa-ro, Gyeyang-gu, 21080 Incheon, Republic of Korea
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Quintana-Villamandos B, González del Pozo I, Pazó-Sayós L, Bellón JM, Pedraz-Prieto Á, Pinto ÁG, Delgado-Baeza E. Plasma protein thiolation index (PTI) as a potential biomarker for left ventricular hypertrophy in humans. PLoS One 2019; 14:e0216359. [PMID: 31067252 PMCID: PMC6505886 DOI: 10.1371/journal.pone.0216359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/18/2019] [Indexed: 01/11/2023] Open
Abstract
Background Left ventricular hypertrophy (LVH) has been associated with oxidative stress, although not with the protein thiolation index (PTI). This study explored the potential use of PTI as a biomarker of oxidative stress in patients with LVH. Methods We recruited 70 consecutive patients (n = 35 LVH and n = 35 non-LVH) based on an echocardiography study in our institution (left ventricular mass indexed to body surface area). Plasma levels of both S-thiolated protein and total thiols were measured as biomarkers of oxidative stress by spectrophotometry, and PTI was calculated as the molar ratio between S-thiolated proteins and the total thiol concentration. Results Values for plasma S-thiolated proteins were higher in patients with LVH than in the control group (P = 0.01). There were no differences in total thiols between the LVH group and the control group. Finally, PTI was higher in patients with LVH than in the control group (P = 0.001). The area under the ROC curve was 0.75 (95% CI, 0.63–0.86; P<0.001), sensitivity was 70.6%, and specificity was 68.6%, thus suggesting that PTI could be used to screen for LVH. A multivariable logistic regression model showed a positive association (P = 0.02) between PTI and LVH (OR = 1.24 [95% CI, 1.03–1.49]) independently of gender (OR = 3.39 [95% CI, 0.60–18.91]), age (OR = 1.03 [95% CI, 0.96–1.10]), smoking (OR = 5.15 [95% CI, 0.51–51.44]), glucose (OR = 0.99 [95% CI, 0.97–1.01]), systolic arterial pressure (OR = 1.10 [CI 1.03–1.17]), diastolic arterial pressure (OR = 0.94 [CI 0.87–1.02]), dyslipidemia (OR = 1.46 [95% CI, 0.25–8.55]), estimated glomerular filtration rate (OR = 0.98 [95% CI, 0.96–1.01]), body mass index (OR = 1.03 [95% CI, 0.90–1.10]), and valvular and/or coronary disease (OR = 5.27 [95% CI, 1.02–27.21]). Conclusions The present study suggests that PTI could be a new biomarker of oxidative stress in patients with LVH.
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Affiliation(s)
- Begoña Quintana-Villamandos
- Departamento de Anestesiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Departamento de Farmacología y Toxicología, Facultad Medicina, Universidad Complutense de Madrid, Madrid, Spain
- * E-mail:
| | - Irene González del Pozo
- Departamento de Anestesiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Laia Pazó-Sayós
- Departamento de Anestesiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jose María Bellón
- Departamento de Estadística, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Álvaro Pedraz-Prieto
- Departamento de Cirugía Cardiovascular, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ángel G. Pinto
- Departamento de Cirugía Cardiovascular, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Emilio Delgado-Baeza
- Unidad de Medicina y Cirugía Experimental, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Bula K, Ćmiel A, Sejud M, Sobczyk K, Ryszkiewicz S, Szydło K, Wita M, Mizia-Stec K. Electrocardiographic criteria for left ventricular hypertrophy in aortic valve stenosis: Correlation with echocardiographic parameters. Ann Noninvasive Electrocardiol 2019; 24:e12645. [PMID: 30896064 DOI: 10.1111/anec.12645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/13/2019] [Accepted: 01/27/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Aortic valve stenosis (AS) generates a chronic pressure overload that induces left ventricular hypertrophy (LVH). The aim of this study was to assess the prevalence of the electrocardiographic criteria for LVH in patients with clinically significant AS and to evaluate the relationship between the ECG criteria for LVH and echocardiographic parameters. METHODS The clinical data of 95 patients with moderate to severe AS were retrospectively analyzed. Eight ECG criteria for LVH were used and compared to the results of transthoracic echocardiography (TTE). RESULTS In 59% of patients, at least one of the ECG criteria for LVH was found. These patients had a greater LVMI (142.1 ± 35.6 vs. 124.1 ± 22.5 g/m2 , p = 0.01) and peak aortic jet velocity (4.2 ± 0.8 vs. 3.8 ± 0.9 m/s, p = 0.01) along with smaller aortic valve area (0.72 ± 0.28 vs. 0.86 ± 0.22 cm2 , p = 0.02) compared to patients with a negative ECG for LVH. The ECG parameters had a low sensitivity (6%-36.9%) with a specificity of up to 100%. The Cornell Voltage criteria had the best sensitivity with a specificity of 63.6% and the highest correlation with the LVMI (r = 0.38, p < 0.001). All of the ECG parameters correlated positively with the peak aortic jet velocity as well as with the mean aortic gradient. CONCLUSION The electrocardiographic criteria for LVH in patients with moderate or severe AS have a poor sensitivity in identifying LVH confirmed by TTE. The values of the selected ECG criteria for LVH correlate weakly with both the TTE indices of LVH and the markers of AS severity.
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Affiliation(s)
- Karolina Bula
- First Department of Cardiology, School of Medicine in Katowice, Upper Silesian Medical Centre, Medical University of Silesia, Katowice, Poland
| | - Anna Ćmiel
- Students' Scientific Club of First Department of Cardiology, School of Medicine in Katowice, Upper Silesian Medical Centre, Medical University of Silesia, Katowice, Poland
| | - Monika Sejud
- Students' Scientific Club of First Department of Cardiology, School of Medicine in Katowice, Upper Silesian Medical Centre, Medical University of Silesia, Katowice, Poland
| | - Karolina Sobczyk
- Students' Scientific Club of First Department of Cardiology, School of Medicine in Katowice, Upper Silesian Medical Centre, Medical University of Silesia, Katowice, Poland
| | - Sylwia Ryszkiewicz
- Students' Scientific Club of First Department of Cardiology, School of Medicine in Katowice, Upper Silesian Medical Centre, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Szydło
- First Department of Cardiology, School of Medicine in Katowice, Upper Silesian Medical Centre, Medical University of Silesia, Katowice, Poland
| | - Marcin Wita
- First Department of Cardiology, School of Medicine in Katowice, Upper Silesian Medical Centre, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Upper Silesian Medical Centre, Medical University of Silesia, Katowice, Poland
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A Fortified Method to Screen and Detect Left Ventricular Hypertrophy in Asymptomatic Hypertensive Adults: A Korean Retrospective, Cross-Sectional Study. Int J Hypertens 2019; 2018:6072740. [PMID: 30595914 PMCID: PMC6286785 DOI: 10.1155/2018/6072740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/29/2018] [Indexed: 01/19/2023] Open
Abstract
Purpose Left ventricular (LV) mass is determined by the wall thickness and diameter. LV hypertrophy (LVH), the increase in LV mass, is usually screened with electrocardiography but is often insensitive. We tried to fortify the rule to detect LVH using cardiothoracic ratio (CTR) in chest X-ray and well-known risk factors besides electrocardiography. Materials and Methods This retrospective cross-sectional study included asymptomatic hypertensive individuals aged ≥40 y who underwent voluntary checkups including echocardiography. Independent variables to explain LVH (LV mass index>115 g/m2 for men and >95 g/m2 for women calculated on echocardiography) were chosen among Sokolow-Lyon voltage amplitude (SLVA), CTR and cardiovascular risk factors by multiple logistic regression analysis. The diagnostic rule to detect LVH was made by summing up the rounded-off odds ratio of each independent variable and was validated using bootstrapping method. Results Among the 789 cases enrolled (202 females (25.6%), mean age 59.6±8.8 y), 168 (21.3%) had LVH. The diagnostic rule summed female, age≥65 y, BMI≥25 kg/m2, SLVA≥35 mm, and CTR≥0.50 (scoring 1 per each). Its c-statistics was 0.700 (95% CI: 0.653, 0.747), significantly higher (p<0.001) than that of SLVA≥35 mm, 0.522 (95% CI: 0.472, 0.572). The sensitivity and specificity of the model were 61.9% and 72.1% for score≥2 and 30.4% and 92.9% for score≥3. The SLVA≥35 mm criteria showed sensitivity of 12.5% and specificity of 91.9%. Conclusions The rule to sum up the number of the risk factors of female, age≥65 y, BMI≥25 kg/m2, SLVA≥35 mm, and CTR≥0.50 may be a better diagnostic tool for screening LVH, than the electrocardiography-only criteria, at the score≥2.
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Bacharova L, Nikolopoulos N, Zamanis I, Krivosíkova Z, Stefíkova K, Gajdos M. A different effect of obesity on ECG in premenopausal and postmenopausal women. J Electrocardiol 2018; 51:1085-1089. [PMID: 30497735 DOI: 10.1016/j.jelectrocard.2018.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/31/2018] [Accepted: 09/22/2018] [Indexed: 01/03/2023]
Abstract
Both obesity and menopause are significant cardiovascular risk factors. In postmenopausal women the protective effect of estrogens is reduced and menopause is frequently associated with occurrence of other significant cardiovascular factors including obesity. This study was focused on evaluating the effect of obesity on the QRS complex in pre- and postmenopausal women. We present results of analysis of 199 electrocardiograms of pre- and postmenopausal women analyzed in relation to the body mass index within normal limits (BMI 20 to 24.9 kg/m2) and obesity (BMI > 30 kg/m2), respectively. Obesity in premenopausal women and menopause significantly affected both the electrical axis (EA) and maximum QRS spatial vector magnitude (QRSmax). The highest QRSmax and electrical axis values were observed in premenopausal lean women, and they were significantly higher as than in the premenopausal obese women, postmenopausal lean and obese women (QRSmax: 1.66 ± 0.4 mV, 1.17 ± 0.35 mV, 1.4 ± 0.46 mV, and 1.35 ± 0.39 mV, resp.). (EA: 56.4 ± 18.0°, 38.22 ± 18.38°, 45.82 ± 18.63°, and 36.75 ± 17.51°). The differences between obese premenopausal women, lean and obese postmenopausal women were not statistically significant. These differences were reflected in 12-lead ECG amplitude. The presence of additional cardiovascular risk factors did not affect the ECG parameters. Obesity significantly affected QRS complex in premenopausal women. This effect was comparable with the effect of menopause. Because all QRS complex changes were within normal limits, these results suggest that ECG evaluation in women should go beyond traditional diagnostic categories and consider the relationship between ECG changes and two cardiovascular risk factors - obesity and menopause.
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Affiliation(s)
- Ljuba Bacharova
- International Laser Center, Bratislava, Slovak Republic; Institute of Pathophysiology, Medical Faculty, Comenius University, Bratislava, Slovak Republic.
| | - Nikolaos Nikolopoulos
- Institute of Pathophysiology, Medical Faculty, Comenius University, Bratislava, Slovak Republic
| | - Ioannis Zamanis
- Institute of Pathophysiology, Medical Faculty, Comenius University, Bratislava, Slovak Republic
| | - Zora Krivosíkova
- Faculty of Medicine, Slovak Medical University, Bratislava, Slovak Republic
| | - Kornelia Stefíkova
- Faculty of Medicine, Slovak Medical University, Bratislava, Slovak Republic
| | - Martin Gajdos
- Faculty of Medicine, Slovak Medical University, Bratislava, Slovak Republic
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Ioannou A, Papageorgiou N, Singer D, Missouris CG. Registry report of the prevalence of ECG abnormalities and their relation to patient characteristics in an asymptomatic population. QJM 2018; 111:875-879. [PMID: 30239921 DOI: 10.1093/qjmed/hcy212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cardiovascular disease is the leading cause of morbidity and mortality in developed countries. Many patients do not experience symptoms before a first major cardiovascular event. Resting electrocardiogram (ECG) may help identify asymptomatic individuals with a high risk of cardiovascular disease. OBJECTIVE We sought to determine the prevalence of ECG abnormalities in an apparently symptom-free adult population within a prospective registry. METHODS The registry consisted of 4739 consecutive apparently healthy individuals [age 62.8 ± 6.2 (SD) years; 54% female], referred by their General Practitioners between 2009 and 2013. Patient demographics, and clinical data were obtained, alongside blood tests and a resting ECG. RESULTS ECG abnormalities were present in 1509 (31.8%) subjects and were commoner with increasing age (F = 0.161, p = 0.01), systolic (F = 0.134, p = 0.01) and diastolic (F = 0.44, p = 0.01) blood pressure and waist circumference (F = 0.53, p = 0.01). Left ventricular hypertrophy (LVH) was the most common abnormality (n = 281) and was positively associated with systolic (F = 0.12, p = 0.01) and diastolic blood pressure (F = 0.99, p = 0.01) and male gender (X2 = 60.5, p < 0.01). All ECG abnormalities (except for LVH) were associated with an increasing age, while right bundle branch block (F = 0.041, p = 0.01) and atrial fibrillation (n = 29; F = 0.036, p = 0.05) were associated with the presence of diabetes mellitus (n = 211). Only left bundle branch block (n = 50) was associated with angina (F = 0.05, p = 0.01). CONCLUSIONS Unrecognized cardiac abnormalities are common in middle-aged men and women with no overt symptoms. ECG offers the potential to identify these abnormalities and provide earlier intervention and treatment, and possibly improve cardiovascular outcome.
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Affiliation(s)
- A Ioannou
- Department of Cardiology, Royal Free Hospital, London, UK
| | - N Papageorgiou
- Department of Cardiology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - D Singer
- Department of Internal Medicine, Office of Global Health, Yale University School of Medicine, New Haven, Connecticut, USA
| | - C G Missouris
- Department of Cardiology, Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK
- Medical School, University of Cyprus, Nicosia, Cyprus
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22
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Tague L, Wiggs J, Li Q, McCarter R, Sherwin E, Weinberg J, Sable C. Comparison of Left Ventricular Hypertrophy by Electrocardiography and Echocardiography in Children Using Analytics Tool. Pediatr Cardiol 2018; 39:1378-1388. [PMID: 29774391 DOI: 10.1007/s00246-018-1907-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/08/2018] [Indexed: 12/16/2022]
Abstract
Left ventricular hypertrophy (LVH) is a common finding on pediatric electrocardiography (ECG) leading to many referrals for echocardiography (echo). This study utilizes a novel analytics tool that combines ECG and echo databases to evaluate ECG as a screening tool for LVH. SQL Server 2012 data warehouse incorporated ECG and echo databases for all patients from a single institution from 2006 to 2016. Customized queries identified patients 0-18 years old with LVH on ECG and an echo performed within 24 h. Using data visualization (Tableau) and analytic (Stata 14) software, ECG and echo findings were compared. Of 437,699 encounters, 4637 met inclusion criteria. ECG had high sensitivity (≥ 90%) but poor specificity (43%), and low positive predictive value (< 20%) for echo abnormalities. ECG performed only 11-22% better than chance (AROC = 0.50). 83% of subjects with LVH on ECG had normal left ventricle (LV) structure and size on echo. African-Americans with LVH were least likely to have an abnormal echo. There was a low correlation between V6R on ECG and echo-derived Z score of left ventricle diastolic diameter (r = 0.14) and LV mass index (r = 0.24). The data analytics client was able to mine a database of ECG and echo reports, comparing LVH by ECG and LV measurements and qualitative findings by echo, identifying an abnormal LV by echo in only 17% of cases with LVH on ECG. This novel tool is useful for rapid data mining for both clinical and research endeavors.
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Affiliation(s)
- Lauren Tague
- Division of Cardiology, Children's National Health System, Washington, DC, USA.
- Department of Cardiology, Children's National Health System, 111 Michigan Avenue NW, Suite WW3-200, Washington, DC, 20010, USA.
| | - Justin Wiggs
- Division of Cardiology, Children's National Health System, Washington, DC, USA
| | - Qianxi Li
- Philips Research North America, Cambridge, MA, USA
| | - Robert McCarter
- Division of Biostatistics and Study Methods, Children's National Health System, Washington, DC, USA
| | - Elizabeth Sherwin
- Division of Cardiology, Children's National Health System, Washington, DC, USA
| | - Jacqueline Weinberg
- Division of Cardiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Craig Sable
- Division of Cardiology, Children's National Health System, Washington, DC, USA
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23
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Afify HMA, Waits GS, Ghoneum AD, Cao X, Li Y, Soliman EZ. Peguero Electrocardiographic Left Ventricular Hypertrophy Criteria and Risk of Mortality. Front Cardiovasc Med 2018; 5:75. [PMID: 30013976 PMCID: PMC6036297 DOI: 10.3389/fcvm.2018.00075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/31/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Peguero electrocardiographic left ventricular hypertrophy (ECG-LVH) criteria are newly developed criteria that have shown better diagnostic performance than the traditional Cornell-voltage and Sokolow-Lyon criteria. However, prediction of poor outcomes rather than detection of increased left ventricular mass is becoming the primary use for ECG-LVH criteria which requires investigating any new ECG-LVH criteria in terms of prediction. Aims: To examine the prognostic significance of the newly developed Peguero ECG-LVH criteria. Methods: We compared the prognostic significance of Peguero ECG-LVH with Cornell-voltage and Sokolow-Lyon ECG-LVH criteria in 7,825 participants (age 59.8 ± 13.4 years; 52.7% women) from the third National Health and Nutrition Examination Survey who were free of major intraventricular conduction defects. ECG-LVH criteria were derived from digital ECG tracings processed at a central core laboratory. Results: At baseline, ECG-LVH was detected in 11.8% by Peguero; in 4.3% by Cornell voltage and in 6.4% by Sokolow-Lyon. During a median follow up of 13.8 years, 2,796 all-cause mortality events occurred. In multivariable models adjusted for demographics and cardiovascular risk factors, presence of Peguero ECG-LVH was associated with increased risk of all-cause mortality [HR (95% CI): 1.29 (1.16, 1.44)]. This association was not significantly different from the associations of Cornell voltage-LVH or Sokolow-Lyon LVH with all-cause mortality [HR (95%CI): 1.32 (1.12, 1.55) and 1.24 (1.07, 1.43), respectively; p-values for comparisons of these HRs with the HR of Peguero ECG-LVH 0.817 and 0.667, respectively]. Similar patterns of associations were observed with cardiovascular, ischemic heart disease and heart failure mortalities. Conclusion: Peguero ECG-LVH is predictive of increased risk of death similar to the traditional ECG-LVH criteria.
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Affiliation(s)
- Hesham M A Afify
- Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - George S Waits
- Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Alia D Ghoneum
- Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Xiangkun Cao
- Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Yabing Li
- Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC, United States.,Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston Salem, NC, United States
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24
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Causal Pathways from Blood Pressure to Larger Qrs Amplitudes a Mendelian Randomization Study. Sci Rep 2018; 8:5817. [PMID: 29643338 PMCID: PMC5895613 DOI: 10.1038/s41598-018-24002-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 03/14/2018] [Indexed: 12/29/2022] Open
Abstract
Abnormal QRS duration and amplitudes on the electrocardiogram are indicative of cardiac pathology and are associated with adverse outcomes. The causal nature of these associations remains uncertain and could be due to QRS abnormalities being a symptom of cardiac damage rather than a factor on the causal pathway. By performing Mendelian randomization (MR) analyses using summary statistics of genome wide association study consortia with sample sizes between 20,687 and 339,224 individuals, we aimed to determine which cardiovascular risk factors causally lead to changes in QRS duration and amplitude (Sokolow-Lyon, Cornell and 12-leadsum products). Additionally, we aimed to determine whether QRS traits have a causal relationship with mortality and longevity. We performed inverse-variance weighted MR as main analyses and MR-Egger regression and weighted median estimation as sensitivity analyses. We found evidence for a causal relationship between higher blood pressure and larger QRS amplitudes (systolic blood pressure on Cornell: 55SNPs, causal effect estimate per 1 mmHg = 9.77 millimeters·milliseconds (SE = 1.38,P = 1.20 × 10−12) and diastolic blood pressure on Cornell: 57SNPs, causal effect estimate per 1 mmHg = 14.89 millimeters·milliseconds (SE = 1.82,P = 3.08 × 10−16), but not QRS duration. Genetically predicted QRS traits were not associated with longevity, suggesting a more prominent role of acquired factors in explaining the well-known link between QRS abnormalities and outcome.
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25
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Adjustments of Electrocardiographic Criteria for the Diagnosis of Left Ventricular Hypertrophy. J Am Coll Cardiol 2017; 70:686-687. [DOI: 10.1016/j.jacc.2017.04.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 04/05/2017] [Indexed: 11/22/2022]
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26
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Poor Sensitivity and Specificity of Electrocardiographic Estimation of Myocardial Mass. J Am Coll Cardiol 2017; 69:1098-1099. [DOI: 10.1016/j.jacc.2016.10.082] [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: 10/03/2016] [Accepted: 10/11/2016] [Indexed: 11/17/2022]
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