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Sokolow-Lyon voltage criteria in sickle cell patients
L Foucan1, A Haddad, I Genevier
1Service de Médecine, Centre Hospitalier Universitaire, Guadeloupe, French West Indies.
Insights
Electrocardiographic left ventricular hypertrophy (LVH) is common in sickle cell patients, particularly those with SS disease. The Sokolow-Lyon criteria often indicate eccentric LVH with increased left ventricular internal dimension in these individuals.
Area of Science:
- Cardiology
- Hematology
- Medical Diagnostics
Background:
- Electrocardiogram (ECG) is a primary cardiac assessment tool in developing nations.
- Sickle cell disease (SCD) patients exhibit unique cardiovascular complications.
- Left ventricular hypertrophy (LVH) is a significant cardiac concern in SCD.
Purpose of the Study:
- To determine the prevalence of electrocardiographic LVH (ECGLVH) in sickle cell patients.
- To assess the clinical significance of Sokolow-Lyon voltage criteria in SCD.
- To correlate ECG findings with echocardiographic measurements in SCD.
Main Methods:
- Studied 112 sickle cell patients (71 SS, 41 SC) with echocardiography and ECG.
- Defined ECGLVH using Sokolow-Lyon voltage criteria (≥ 35 mm).
- Analyzed correlations between ECG parameters and echocardiographic measurements (LV mass, dimensions, wall thickness).
Main Results:
- ECGLVH prevalence was 55% in SS and 27% in SC patients, higher in males.
- ECGLVH correlated significantly with patient height and left ventricular internal dimension.
- Sokolow-Lyon criteria showed moderate sensitivity (63% in SS, 33% in SC) and variable specificity for detecting echocardiographic LVH.
- Sokolow-Lyon voltage correlated with increased left ventricular mass and internal dimension.
Conclusions:
- ECG-detected LVH in sickle cell patients primarily signifies eccentric LVH with increased left ventricular internal dimension.
- Sokolow-Lyon criteria provide valuable, though not perfect, assessment of LVH in SCD.
- Further research into cardiovascular adaptations in SCD is warranted.
Abstract:
The electrocardiogram remains the most commonly used method of cardiac assessment in developing countries. To determine the prevalence of electrocardiographic left ventricular hypertrophy (LVH) and the clinical significance of Sokolow-Lyon voltage criteria in sickle cell patients, echocardiographic and ECG findings were studied in 112 patients (71 with haemoglobin SS disease and 41 with haemoglobin SC disease). Electrocardiographic left ventricular hypertrophy (ECGLVH) defined as Sokolow-Lyon voltage > or = 35 mm was detected in 39 (55%) SS patients and 11 (27%) SC patients. This prevalence was higher in men than in women. There were statistically significant trends for increasing prevalence of ECGLVH with height (p < 0.007 in SS, and p < 0.01 in SC, patients) and with left ventricular internal dimension (p < 0.05 in SS, and p < 0.01 in SC, patients). But no significant trend was found with increasing posterior wall (PWT) or interventricular septal thickness (IVST). Sensitivity of Sokolow-Lyon criteria for detection of echocardiographic left ventricular hypertrophy was 63% and 33% in SS and SC patients, respectively, and specificity was 51% and 74%, respectively. Sokolow-Lyon voltage correlated with left ventricular mass in SS and SC patients (r = 0.44, p < 0.01 and r = 0.32, p < 0.05) and with left ventricular internal dimension (r = 0.2, p < 0.01 and r = 0.32, p < 0.05) but not significantly with PWT and IVST. We conclude that, in sickle cell patients, the electrocardiographic LVH mainly indicates the existence of an eccentric echocardiographic LVH with increase of left ventricular internal dimension.