Electrocardiographic criteria for the diagnosis of abnormal hypertensive cardiac phenotypes

Abstract

This article compared the performance of 18 electrocardiographic (ECG) left ventricular hypertrophic (LVH) criteria and four P-wave indices for the diagnosis of echocardiographic (ECHO) LVH and left atrial enlargement (LAE), including the deepest S-wave amplitude added to the S-wave amplitude of lead V₄ (S_D +SV₄ ) and P-wave terminal force in lead V₁ (PTFV₁ ). A total of 152 middle-aged hypertensive patients without evident cardiovascular diseases (CVDs) were enrolled. The gold standard for the diagnosis of LVH and LAE was ECHO left ventricular mass index (LVMI) and largest left atrial volume index (LAVI). For the detection of LVH, Sokolow-Lyon voltage, Cornell voltage, Cornell product, S_D +SV₄ , Manning, and R+S in any precordial lead had relatively higher sensitivity, especially S_D +SV₄ criteria. Their combination could further increase sensitivity (43% vs 29% [S_D +SV₄ ], P = 0.016). PTFV₁ was the only criterion that had significant diagnostic value for ECHO LAE (AUC, 0.68; 95% CI: 0.54-0.73, P = 0.008). For middle-aged hypertensive patients without evident cardiovascular diseases, S_D +SV₄ had the highest sensitivity for the diagnosis of LVH and the combination of several ECG LVH criteria might further increase sensitivity. PTFV₁ had significant diagnostic value for ECHO LAE.