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Updated: Jul 12, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Relationship of electrocardiographic repolarization measures to echocardiographic left ventricular mass in men with
Kimmo Porthan1, Juha Virolainen, Timo P Hiltunen
1Department of Cardiology, Helsinki University Central Hospital, Finland. porthan@mappi.helsinki.fi
Insights
Hypertension can cause subtle changes in heart repolarization even with mild left ventricular mass increase. These electrocardiographic alterations may indicate reduced repolarization reserve and increased risk in hypertensive patients.
Area of Science:
- Cardiology
- Electrophysiology
- Hypertension Research
Background:
- Arterial hypertension commonly leads to increased left ventricular mass (LVM).
- Significant left ventricular hypertrophy (LVH) is linked to ventricular repolarization abnormalities and sudden cardiac death risk.
- Early detection of repolarization changes in mild LVM increase is crucial.
Purpose of the Study:
- To investigate whether electrocardiographic repolarization changes are detectable in hypertensive individuals with only mild increases in left ventricular mass.
- To assess the relationship between left ventricular mass and various electrocardiographic repolarization parameters.
Main Methods:
- Studied 220 men from the GENRES hypertension study (mean age 51 years).
- Measured QT intervals (QTend, QTpeak), T-wave peak to T-wave end (TPE) intervals, and T-wave morphology parameters from 12-lead ECG.
- Related ECG parameters to echocardiographically determined left ventricular mass (LVM).
Main Results:
- Mean LVM index (LVMI) was 99+/-19 g/m2; 18% had echocardiographic LVH.
- LVMI significantly correlated with QT intervals, TPE intervals, and T-wave morphology parameters (P<0.001).
- Relationships between LVMI and ECG repolarization parameters were largely independent in multivariate analyses.
Conclusions:
- Altered electrocardiographic ventricular repolarization is present even with mild LVM increase in hypertensive men.
- These findings suggest reduced repolarization reserve and potential heterogeneity.
- This may have significant risk implications for the broader hypertensive population.
Objective:
Arterial hypertension often leads to an increase in left ventricular mass (LVM). Marked left ventricular hypertrophy (LVH) is associated with potentially arrhythmogenic ventricular repolarization abnormalities, which may contribute to the increased risk of sudden cardiac death in this disorder. We studied whether electrocardiographic repolarization changes are already detectable in mild LVM increase associated with hypertension.
Methods:
In 220 men (mean age 51+/-6 years) attending the GENRES hypertension study, we measured QT intervals (QTend and QTpeak), T-wave peak to T-wave end (TPE) intervals, and novel T-wave morphology parameters (principal component analysis ratio, T-wave morphology dispersion, total cosine R-to-T, and T-wave residuum) from a digital standard 12-lead electrocardiogram, and related them to echocardiographically determined LVM.
Results:
In this group of moderately hypertensive men, the mean LVM index (LVMI; LVM divided by body surface area) was 99+/-19 g/m2, with only 18% of the subjects showing evidence of echocardiographic LVH (LVMI>116 g/m2). LVMI correlated significantly with QT intervals (r=0.16-0.21, P=0.018-0.002), TPE intervals (r=0.23-0.27, P<0.001), and T-wave morphology parameters (r=0.22-0.39, P<0.001). Except for the QTpeak interval, the relationship between LVMI and electrocardiographic repolarization parameters was independent in multivariate analyses.
Conclusion:
Altered electrocardiographic ventricular repolarization, indicating reduced repolarization reserve and possibly increased repolarization heterogeneity, is already present in hypertensive men with only mild LVM increase. At a population level, this may carry important risk implications for the large group of hypertensive patients.
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