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Published on: October 28, 2020
Left ventricular mass and hypertrophy assessment by means of the QRS complex voltage-independent measurements
Maciej Sosnowski1, Barbara Korzeniowska, Michał Tendera
13rd Division of Cardiology, Silesian Medical School, Ziolowa Street 47, 40-635 Katowice, Poland. msos@poczta.onet.pl
Insights
A new electrocardiogram (ECG) index, based on QRS complex duration, effectively detects left ventricular hypertrophy (LVH) in coronary artery disease (CAD) patients. This time-dependent index outperforms traditional voltage-based ECG criteria for assessing left ventricular mass (LVM).
Area of Science:
- Cardiology
- Medical Diagnostics
- Biomedical Engineering
Background:
- Electrocardiogram (ECG) QRS-complex voltage criteria have limited sensitivity for detecting increased left ventricular mass (LVM).
- Accurate assessment of LVM is crucial for managing cardiovascular conditions, particularly in patients with coronary artery disease (CAD).
- Existing ECG methods often struggle to reliably identify left ventricular hypertrophy (LVH).
Purpose of the Study:
- To develop and evaluate a novel ECG index for detecting LVH, independent of QRS voltage.
- To compare the diagnostic performance of the new index against established ECG criteria and echocardiography.
- To assess the feasibility of using a time-dependent ECG index for LVM assessment in CAD patients.
Main Methods:
- A new ECG index, LVM(ECG), was calculated using QRS duration and time to maximal deflection.
- The study included 106 CAD patients (73 male, 33 female, aged 60±10 years) with echocardiographically assessed LVM (LVMI(ECHO)).
- ECG variables including QRS duration, time to maximal deflection, and various voltage-based indices were analyzed.
Main Results:
- The new index, LVMI(ECG), demonstrated superior performance in distinguishing between patients with and without LVH (p < 0.001).
- LVMI(ECG) showed a strong correlation with echocardiographically determined LVM (r = 0.77, p < 0.001), outperforming other ECG indices.
- At 92% specificity, LVMI(ECG) achieved 64% sensitivity for detecting increased LVM, significantly higher than other tested indices (18-42%).
Conclusions:
- A novel time-dependent ECG index (LVMI(ECG)) is feasible for assessing LVM and detecting LVH in CAD patients.
- The new index exhibits better statistical performance and correlation with echocardiography compared to traditional voltage-based ECG criteria.
- These promising results suggest the potential utility of LVMI(ECG) as a valuable tool for risk prediction in cardiovascular disease.
Unlabelled:
ECG QRS-complex voltage-based criteria are relatively insensitive for detection of increased left ventricular mass (LVM). We developed and evaluate a new ECG index for LV hypertrophy (LVH) detection regardless of the QRS voltage.
Methods:
Study population consisted of 106 patients (73 m, 33 f, aged 60 +/- 10 years) with established coronary artery disease (CAD). All patients had LVM assessed echocardiographically and indexed to BSA (LVMI(ECHO)). LVH was diagnosed if LVMI(ECHO) >117 g/m2 in men and >104 g/m2 in women. LV geometry was also determined. Analysed ECG variables, obtained from 12 leads recorded simultaneously, were: the QRS complex duration (QRSd, ms), the average 12-lead time to maximal deflection (TMD, ms), the average 12-lead QRS complex voltage (12QRSV, mV), the average product of 12 lead QRS voltage and duration (12QRSVd, mV ms), Sokolow-Lyon voltage and V-d product (SLV, SLVd), Cornell voltage and V-d product (CV, CVd). A newly developed index, LVM(ECG), was calculated, as LVM(ECG) = [(2 x TMD+QRSd/pi)3-(QRSd/pi)3]*0.0001 (ms3), and indexed to BSA (LVMI(ECG), ms3/m2).
Results:
Means of the QRS voltage-related parameters were similar in patients with LVH and normal LVM. Greater differences existed between both groups when the QRS voltage-duration products were compared. LVMI(ECG) was most powerful in distinguishing between groups (130 +/- 33 LVH vs 91 +/- 21 normal LVM, p < 0.001). LVMI(ECG) correlated with LVMI(ECHO) better (r = 0.77, p < 0.001) than other indices (r coefficients between 0.24 for SLV and 0.49 for CVd). None of the examined indices allowed for distinction between eccentric and concentric LVH. The new index showed better statistical performance (area under ROC = 0.861) compared to the other indices (AUC range 0.545-0.697, p<0.001 vs LVMI(ECG)). At the specificity level of 92%, the value of LVMI(ECG) > 120 ms3/m2 had the sensitivity of 64% for detection of increased LVM. The sensitivities of the other parameters were significantly lower (sensitivity range 18-42%). Relative intra- and interobserver errors and correlation coefficients for LVMI(ECG) calculation were 0.4% and 1.6% and r = 0.94 and 0.98, respectively.
Conclusions:
In patients with CAD an assessment of LV mass and detection of hypertrophy using the QRS complex time-dependent index is feasible. The new index correlated well with echocardiographically-determined LVM and showed better statistical performance than indices which include QRS-voltage measurements. The results are promising and warrant further studies to evaluate the utility of the new index as a risk predictor.
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