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Published on: October 28, 2020
Discrepancy between left ventricular hypertrophy by echocardiography and electrocardiographic hypertrophy: clinical
Yuta Seko1, Takao Kato2, Yuhei Yamaji3
1Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Insights
Echocardiography-detected left ventricular hypertrophy (LVH) without ECG confirmation indicates a significant risk for adverse cardiovascular events. This risk is comparable to having LVH detected by both methods, highlighting the importance of echocardiography findings.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Research
Background:
- The clinical significance of discrepancies between electrocardiogram (ECG) and echocardiography (echo) for diagnosing left ventricular hypertrophy (LVH) is not fully understood.
- Accurate LVH assessment is crucial for predicting cardiovascular outcomes.
- Existing diagnostic criteria for LVH by ECG and echo may not always align.
Purpose of the Study:
- To investigate the clinical significance of discordance between ECG-based and echo-based LVH.
- To evaluate the association of different LVH detection patterns with adverse cardiovascular events.
- To determine the prognostic value of echo-detected LVH independent of ECG findings.
Main Methods:
- Retrospective analysis of 3212 patients who underwent both transthoracic echocardiography and ECG.
- Exclusion criteria included pacemaker use, QRS duration ≥120 ms, cardiomyopathy, and moderate-to-severe valvular disease.
- LVH definitions: ECG-based (Cornell product >2440 mm·ms), Echo-based (left ventricular mass index >115 g/m² for men, >95 g/m² for women).
Main Results:
- Patients were categorized into: both LVH (4.1%), only echo LVH (4.9%), only ECG LVH (12.7%), and no LVH (78.3%).
- The 3-year cumulative incidence of all-cause death and major adverse cardiovascular events was highest in the 'only echo LVH' group (33.8%) and the 'both LVH' group (32.0%).
- Adjusted analysis showed significantly higher risks for 'both LVH' (HR 1.63) and 'only echo LVH' (HR 1.68) compared to no LVH.
Conclusions:
- Left ventricular hypertrophy detected by echocardiography but not by ECG is associated with a significant risk of adverse clinical events.
- The risk observed in patients with echo-based LVH alone is comparable to that in patients with LVH confirmed by both methods.
- Echocardiography plays a vital role in identifying patients at risk, even when ECG criteria for LVH are not met.
Background:
The clinical significance of the discrepancy between left ventricular hypertrophy (LVH) by echocardiography and ECG remains to be elucidated.
Methods:
After excluding patients who presented with pacemaker placement, QRS duration ≥120 ms and cardiomyopathy and moderate to severe valvular disease, we retrospectively analysed 3212 patients who had undergone both scheduled transthoracic echocardiography (echo) and ECG in a hospital-based population. Cornell product >2440 mm · ms was defined as ECG-based LVH; left ventricular mass index >115 g/m2 for men and >95 g/m2 for women was defined as echo-based LVH. The study population was categorised into four groups: patients with both ECG-based and echo-based LVH (N=131, 4.1%), those with only echo-based LVH (N=156, 4.9%), those with only ECG-based LVH (N=409, 12.7%) and those with no LVH (N=2516, 78.3%).
Results:
The cumulative 3-year incidences of a composite of all-cause death and major adverse cardiovascular events were 32.0%, 33.8%, 19.2% and 15.7%, respectively. After adjusting for confounders, the HRs relative to that in no LVH were 1.63 (95% CI 1.16 to 2.28), 1.68 (95% CI 1.23 to 2.30) and 1.09 (95% CI 0.85 to 1.41) in patients with both ECG-based and echo-based LVH, those with only echo-based LVH, and those with only ECG-based LVH, respectively.
Conclusions:
Echo-based LVH without ECG-based LVH was associated with a significant risk of adverse clinical events, and the risk was comparable to that in patients with both echo-based and ECG-based LVH.
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