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Electrocardiographic voltage criteria in patients with hypertrophic cardiomyopathy
Luca Monzo1,2, Annamaria Martino1, Chiara Lanzillo1
1Department of Cardiology, Policlinico Casilino.
Insights
Electrocardiogram (ECG) voltage criteria show limited accuracy for diagnosing left ventricular hypertrophy (LVH) in hypertrophic cardiomyopathy (HCM) patients. Specific criteria performed better in certain HCM subtypes, but overall correlation with cardiac MRI findings was poor.
Area of Science:
- Cardiology
- Medical Diagnostics
- Biomedical Engineering
Background:
- Electrocardiogram (ECG) voltage criteria are established for diagnosing left ventricular hypertrophy (LVH).
- These criteria have primarily been validated in concentric LVH, not asymmetric hypertrophy characteristic of hypertrophic cardiomyopathy (HCM).
Purpose of the Study:
- To assess the diagnostic performance of standard ECG voltage criteria for LVH in patients with HCM.
- To compare the effectiveness of various ECG criteria across different patterns of HCM hypertrophy.
Main Methods:
- Evaluated 92 HCM patients and 41 controls using common ECG voltage criteria for LVH.
- Utilized cardiac magnetic resonance (MRI) to quantify LVH and hypertrophy distribution in all participants.
Main Results:
- Maximal diagnostic accuracy for LVH in HCM was 58% with Amplitude total criteria.
- Specific criteria showed varied performance in different HCM morphologies: Cornell Voltage (septal), Sokolov/Gubner (apical), and Cornell Voltage/Product (anterior).
- All ECG criteria demonstrated poor correlation with left ventricular mass and thickness measured by cardiac MRI.
Conclusions:
- Few ECG voltage criteria offer acceptable performance for LVH detection in HCM.
- Further research is necessary to define the precise role of ECG in diagnosing LVH within the HCM population.
Background:
Several ECG voltage criteria have been proposed for the diagnosis of left ventricular hypertrophy (LVH). Notably, ECG criteria have been historically validated in concentric LVH but not in hypertrophic cardiomyopathy (HCM), wherein the hypertrophy pattern is typically asymmetric.
Objectives:
The aim of our study was to evaluate the performance of ECG voltage criteria for LVH diagnosis in the HCM population.
Material And Methods:
The electrocardiograms of 92 HCM patients and 41 sex- and age-matched controls were evaluated with the most frequently used ECG voltage criteria for LVH diagnosis. Cardiac magnetic resonance (MRI) was performed in HCM and controls in order to quantify LVH and its distribution.
Results:
In the HCM population, the maximal diagnostic accuracy was achieved by Amplitude total and Amplitude total product criteria (58% for both), while the Cornell Voltage best performed in septal HCM (62%), the Sokolov in aVL and Gubner criteria in apical HCM (79% for both) and the Cornell Voltage and Product in anterior HCM (86% for both). All the ECG voltage criteria showed a poor correlation with left ventricular mass and maximal thickness measured by cardiac MRI.
Conclusions:
In our study, only a few ECG voltage criteria used for the detection of LVH in clinical practice showed an acceptable performance in the HCM population. Further studies are needed to clarify the role of ECG for LVH detection in HCM patients.
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