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[Evaluation of electrocardiographic left ventricular hypertrophy with both QRS voltage and ST-T change using
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Electrocardiogram (ECG) QRS voltage criteria combined with ST-T wave changes improve left ventricular hypertrophy (LVH) diagnosis. This ECG approach is more effective than using QRS voltage alone for detecting LVH, especially in hypertrophic cardiomyopathy patients.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Medical Electrocardiography
Background:
- Left ventricular hypertrophy (LVH) is a significant indicator of cardiovascular disease.
- Electrocardiography (ECG) is a primary tool for cardiac assessment.
- Existing ECG criteria for LVH, like the Sokolow-Lyon voltage criteria, have limitations.
Purpose of the Study:
- To evaluate the diagnostic utility of ECG QRS voltage criteria combined with ST-T wave changes for identifying left ventricular hypertrophy (LVH).
- To compare the effectiveness of combined ECG criteria versus QRS voltage criteria alone in diagnosing LVH.
- To correlate ECG findings with echocardiographic measurements of LVH.
Main Methods:
- One hundred men, including those with hypertension and hypertrophic cardiomyopathy, underwent ECG and echocardiography.
- Participants were categorized based on Sokolow-Lyon voltage criteria and ST-T wave patterns (Normal, Early Strain, Strain).
- Echocardiographic LVH was defined by increased interventricular septal thickness (IVST) or left ventricular posterior wall thickness (LVPWT).
Main Results:
- The diagnostic accuracy for LVH increased with the addition of ST-T wave patterns: 31.7% (Normal ST-T), 75.0% (Early Strain), and 100% (Strain).
- Significant correlations were found between QRS voltage indices and echocardiographic LVH parameters (IVST, LV mass) in the Strain group.
- Patients in the Strain group exhibited significantly greater IVST and LV mass compared to the other groups.
Conclusions:
- ECG diagnosis of LVH is enhanced by incorporating ST-T wave changes alongside QRS voltage criteria.
- The combination of QRS voltage and ST-T wave patterns provides a more robust method for detecting LVH than QRS voltage alone.
- This integrated ECG approach offers improved diagnostic value, particularly in identifying significant LVH.
Abstract:
The purpose of the present study is to determine whether electrocardiographic QRS voltage criteria with ST-T change is useful in the diagnosis of left ventricular hypertrophy (LVH) using echocardiography. One hundred men including 59 with hypertension (HT), 9 with hypertrophic cardiomyopathy (HCM), and 32 without any cardiovascular disease were enrolled in this study. All of them had the electrocardiographic evidence of LVH by Sokolow-Lyon voltage criteria (RV5 or RV6 > 2.6 mV, SV1+RV5 or SV1+RV6 > or = 3.5 mV). They were classified into three groups based on ST-T pattern as follows: Normal ST-T (group N): normal ST-T in twelve leads; Early strain ST-T (group ES): ST depression, flat T (T/R < 1/10), diphasic T or T wave inversion < 0.1 mV in V5 or V6; and Strain ST-T (group S): inverted T wave in V5 and V6. Echocardiographic LVH was determined when either interventricular septal thickness (IVST) or left ventricular posterior wall thickness (LVPWT) > or = 12 mm was present. According to this echocardiographic evidence, 31.7%(20/63) of group N, 75.0% (12/16) of group ES, and 100% (21/21) of group S were diagnosed. There were significant correlations between QRS voltage indices (RV5, RV6, SV1+RV5 and SV1+RV6) and IVST, (IVST+LVPWT)/2, and LV mass in group S(r = 0.650 to 0.858, p < 0.05) but not in group N. Values for IVST and LV mass were significantly greater in group S than in group ES or N. The electrocardiographic diagnosis of LVH with both QRS voltage and ST-T change thus appeared to be more useful than that with QRS voltage criteria alone.