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CMR ventriculometry for evaluation of ecg hypertrophy criteria in a preventive medicine population

  • Holger C Eberle1,
  • Ulrike Stevka1,
  • Mani Farazandeh1,
  • Cristoph J Jensen1,
  • Thomas Schlosser2,
  • Kai Nassenstein2,
  • Christoph K Naber1,
  • Georg V Sabin1 and
  • Oliver Bruder1
Journal of Cardiovascular Magnetic Resonance201113(Suppl 1):P244

https://doi.org/10.1186/1532-429X-13-S1-P244

Published: 2 February 2011

Keywords

Cardiovascular Magnetic ResonanceLeft Ventricular HypertrophyDuration ProductShort Axis CineDelay Enhancement Imaging

Introduction

Left ventricular hypertrophy (LVH) is an important prognosticator for cardiovascular (CV) risk in persons with and without arterial hypertension. Given the high prevalence of these conditions, LVH screening is mandatory for CV prevention. Although not evaluated in a middle aged preventive medicine population, Electrocardiography (ECG) is widely used for LVH screening. Although not widely accessible as a screening technique, cardiovascular magnetic resonance (CMR) offers a unique opportunity to calculate LV mass index (LVMI) as the gold standard for other diagnostic tests.

Purpose

To assess the reliability of ECG LVH criteria compared to CMR ventriculometry (cutoff: LVMI 83 g/m2) and the incremental value of CMR in a population from a prevention programme.

Methods

220 (206 male, age 49.5 ± 8,4 years) consecutive participants of a prevention programme without known heart disease underwent CMR in a 1.5 T scanner (Magnetom Avanto, Siemens, Erlangen, Germany) including SSFP Cine (TrueFISP TR 3ms, TE 1.5 ms, FA 72°, slice thickness 6 mm) and delayed enhancement imaging.

LVMI was derived from contiguous short axis cine images using the summation of discs method. These data were compared to Sokolow-Lyon amplitude, Sokolow-Lyon duration product, Cornell amplitude, Cornell duration product, and Romhild-Estes score (Tables 1,2) in 12 lead ECG.
Table 1

Calculation of the ECG criteria

Criterion

Calculation

Normal value

Sokolow-Lyon Amplitude (mV)

SV1 + RV5/V6

<3,5

Sokolow-Lyon Duration Product (mm * ms)

(SV1 + RV5/V6) * QRS duration

<2940

Cornell Amplitude (mV)

R aVL + SV3

<2,8

Cornell Duration Product (mm + ms)

(R aVl + SV3) * QRS duration

<2440

Table 2

Romhild Estes Score

Criterion

Points

R or S > 20 mm

or

S in V1 or V2 > 30 mm

or

R in V5 or V6 30 mm

3

ST/T changes typical of LVH, taking digitalis

1

ST/T changes typical of LVH, not taking digitalis

3

P terminal force in V1 1mm or more, duration >40 ms

3

Left axis deviation > -30°

2

QRS dura> 90 ms

1

Intrinsicoid deflection in V5 or V6 >50 ms

1

Results

31 participants had positive LVH criteria in ECG, of which 6, and 4 ECG negatives, showed LVH (LVMI > 83 g/m2) in CMR (Figure 2). All ECG criteria were positively correlated with LV mass (Table 3). Specificities and negative predictive values were high in our low-prevalence population, but sensitivities and positive predictive values were poor (Table 3, Figure 1).

Figure 1
Figure 1

ROC analysis of the ECG criteria to identify LVH

Figure 2
Figure 2

CMR showing LVH with increased LVMI and septal thickness, in a patient with pathologic Sokolow-Lyon Index, Sokolow Duration Product, and REPSS.

Table 3

Diagnostic characteristics and correlation with LVMI of the ECG criteria

Criterion

Correlation Coefficient (Perason)

Sensitivity

Specificity

Posisitive Predictive Value

Negative Predictive Value

Sokolow-Lyon Amplitude

0.413

0.52

0.94

0.26

0.98

Sokolow-Lyon Product

0.436

0.44

0.92

0.18

0.92

Cornell Amplitude

0.224

0.111

0.97

0.14

0.95

Cornell Product

0.231

0.2

0.97

0.11

0.96

REPSS

0.248

0.22

0.93

0.12

0.97

Conclusions

CMR identified a large proportion of false positive ECG results (25/31), and identified additional LVH cases (4/189). ECG is not a reliable LVH screening tool in a middle aged prevention population. LVH screening should be based on imaging techniques.

Authors’ Affiliations

(1)
Elisabeth Hospital Essen, Essen, Germany
(2)
University Hospital Essen, Essen, Germany

Copyright

© Eberle et al; licensee BioMed Central Ltd. 2011

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (<url>http://creativecommons.org/licenses/by/2.0</url>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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