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Electrocardiographic prediction of left ventricular geometric patterns in patients with essential hypertension.

Aktoz M, Erdogan O, Altun A

Department of Cardiology, School of Medicine, Trakya University, Edirne, Turkey.

BACKGROUND: The present study sought to determine the diagnostic value of electrocardiographic voltage criteria in predicting geometry patterns in patients with essential hypertension. METHODS: Patients with essential hypertension (n=125) according to left ventricular mass index and relative wall thickness as determined by echocardiography were assigned in the following groups: normal geometry (N, n=50), concentric remodeling (CR, n=12), concentric hypertrophy (CH, n=28) and eccentric hypertrophy (EH, n=35). Each patient underwent 12-lead ECG followed by determination of conventional voltage criteria as well as peak to peak QRS lengths in each lead. RESULTS: Voltage criteria such as Sokolow-Lyon, Cornell, Cornell product >2440, D1R+D3S >25 mm, and AVL R >11 mm could not significantly predict and discriminate geometric patterns of LVH. However, they all were very specific (range 97-100%) and showed very high positive predictive values (range 94-100%) for detecting abnormal geometry. DI peak >12 mm had a sensitivity 61%, specificity 67%, accuracy 63%, positive predictive value 81%, and negative predictive value 42% in predicting to differentiate CH from CR. Sum of the calculated values from the peak of the R to the nadir of the S wave in all limb leads >60 mm had sensitivity 68%, specificity 75%, accuracy 70%, positive predictive value 86% and negative predictive value 50% in predicting to differentiate CH from CR. CONCLUSIONS: Conventional ECG voltage criteria could not significantly discriminate specific geometry patterns observed in patients with essential hypertension.

Published 23 July 2007 in Int J Cardiol, 120(3): 344-50.
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