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Prediction of the left ventricular mass from the electrocardiogram in systemic hypertension
S O de Vries1, W F Heesen, F W Beltman
1Department of Health Sciences, University of Groningen, The Netherlands.
Insights
Electrocardiography (ECG) can predict left ventricular (LV) mass when echocardiography is unavailable. A new ECG model accurately estimates LV mass, offering a valuable alternative for assessing cardiac health.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Echocardiography is the standard for assessing left ventricular (LV) mass but has accessibility limitations.
- Existing electrocardiogram (ECG) criteria primarily detect LV hypertrophy, not LV mass itself.
- Predicting LV mass from ECG offers a potentially more accessible diagnostic tool.
Purpose of the Study:
- To develop and validate an ECG-based model for predicting left ventricular (LV) mass.
- To compare the predictive accuracy of the new ECG model against existing methods.
- To establish an alternative method for LV mass assessment where echocardiography is not feasible.
Main Methods:
- A community-based survey identified 277 hypertensive subjects for ECG and echocardiography.
- Multiple linear regression analysis was used on a training sample (n=185) with ECG and non-ECG variables.
- The derived model was validated on a separate sample (n=92) to predict LV mass.
Main Results:
- The developed ECG model, using sex, age, body surface area, S-voltage in V1/V4, and P-wave duration in V1, explained 45% of LV mass variance in training and 42% in validation.
- The model's predictive accuracy (r=0.67/0.65) surpassed existing ECG models for LV mass (r=0.40/0.41).
- Traditional ECG criteria for LV hypertrophy showed low correlation with actual LV mass.
Conclusions:
- ECG can reliably predict left ventricular (LV) mass, especially when echocardiography is unavailable or impractical.
- The novel ECG model provides a valuable, accessible alternative for LV mass estimation.
- This approach can aid in cardiovascular risk assessment in diverse clinical settings.
Abstract:
Although echocardiography provides a reliable method to determine left ventricular (LV) mass, it may not be available in all settings. Numerous electrocardiographic (ECG) criteria for the detection of LV hypertrophy have been developed, but few attempts have been made to predict the LV mass itself from the ECG. In a community-based survey program in the general population, 277 subjects were identified with untreated diastolic hypertension (diastolic blood pressure 95 to 115 mm Hg, 3 occasions) or isolated systolic hypertension (diastolic blood pressure <95 mm Hg and systolic blood pressure 160 to 220 mm Hg, 3 occasions). All subjects underwent ECG and echocardiography on the same day. A multiple linear regression analysis was performed using a random training sample of the data set (n = 185). The independent variables included both ECG and non-ECG variables. The resulting model was used to predict the LV mass in the remainder of the data set, the validation sample (n = 92). Using sex, age, body surface area, the S-voltage in V1 and V4, and the duration of the terminal P in V1 as independent variables, the model explained 45% of the variance (r = 0.67) in the training sample and 42% (r = 0.65) in the validation sample. This result exceeded that of 2 existing ECG models for LV mass (r = 0.40 and 0.41). The correlations between LV mass and combinations of ECG variables used for the detection of LV hypertrophy, such as the Sokolow-Lyon Voltage (r = 0.03) and the Cornell Voltage (r = 0.31), were comparatively low. In settings where echocardiography is not available or is too expensive and time-consuming, prediction of the LV mass from the ECG may offer a valuable alternative.