Consistency of left ventricular hypertrophy diagnosed by electrocardiography and echocardiography: the Northern Shanghai Study

Wei Zhang,1,* Yiwu Zhou,1,* Bin Bai,1 Shikai Yu,1 Jing Xiong,1 Chen Chi,1 Jiadela Teliewubai,1 Jue Li,2 Jacques Blacher,3 Yi Zhang,1 Yawei Xu1 1Department of Cardiology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 2Department of Prevention, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 3Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris Descartes University, AP-HP, Paris, France *These authors contributed equally to this work Background: Left ventricular hypertrophy (LVH) is one of the preclinical manifestations of hypertensive target organ damage (TOD). However, it remains unclear which electrocardiographic criterion perform better in diagnosing LVH. Purpose: To investigate the consistency of LVH diagnosed by electrocardiography (ECG) and echocardiography (ECHO). Taking LVH by ECHO as reference, to compare three different ECG criteria (Sokolow-Lyon, Cornell and Cornell Product criteria) and find the best ECG indicator for identifying LVH in community-based elderly Chinese. Patients and methods: Echocardiography and electrocardiography were applied to define LVH in 1789 elderly Chinese aged >65 years old in communities located at the northern Shanghai. Echocardiographic LVH (ECHO-LVH) was defined by left ventricular mass indexed for Body Surface Area (LVM/BSA) or for height2.7 (LVM/height2.7). Electrocardiographic LVH (ECG-LVH) was defined by Sokolow-Lyon (SL), Cornell and Cornell Product (CP) criteria. ECHO-LVH was defined by LVM/BSA≥125 g/m2 in male or ≥110 g/m2 in female (LVH1); LVM/BSA≥115 g/m2 in male, or ≥95 g/m2 in female (LVH2) and LVM/height2.7 ≥51 g/m2.7 in male or ≥47 g/m2.7 in female (LVH3). Results: As compared with SL and Cornell criteria, CP had the greatest correlation coefficient in the association with echocardiography-defined LVH, except for LVM/BSA in men. Of note, CP criterion had the greatest area under curve of ROC than Cornell criterion and the SL index, not only in total population but also in subgroups classified by blood pressure. Conclusion: In ECG-LVH criteria, CP criterion complies better than SL index and Cornell criterion in assessing cardiac hypertrophy. Keywords: left ventricular hypertrophy, electrocardiography, echocardiography, population study, accuracy