Performance of a novel ECG criterion for improving detection of left ventricular hypertrophy: a cross-sectional study in a general Chinese population

Yanli Chen; Guozhe Sun; Xiaofan Guo; Zhao Li; Guangxiao Li; Ying Zhou; Hongmei Yang; Shasha Yu; Liqiang Zheng; Yingxian Sun

doi:10.1136/bmjopen-2021-051172

Performance of a novel ECG criterion for improving detection of left ventricular hypertrophy: a cross-sectional study in a general Chinese population

BMJ Open. 2021 Sep 2;11(9):e051172. doi: 10.1136/bmjopen-2021-051172.

Authors

Yanli Chen¹, Guozhe Sun¹, Xiaofan Guo¹, Zhao Li¹, Guangxiao Li², Ying Zhou¹, Hongmei Yang¹, Shasha Yu¹, Liqiang Zheng³, Yingxian Sun⁴

Affiliations

¹ Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China.
² Department of Medical Record Management Center, The First Hospital of China Medical University, Shenyang, Liaoning, China.
³ Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
⁴ Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China yxsun@cmu.edu.cn.

Abstract

Objectives: The sensitivity of ECG for detecting left ventricular hypertrophy (LVH) is low. The aim of this study was to explore a better ECG criterion for screening LVH in a large general Chinese population.

Design: Case-control study.

Setting: China Medical University in Shenyang, China.

Participants: All permanent residents in Dawa, Zhangwu and Liaoyang aged 35 years or older were invited. Participants with unqualified data, pacemaker rhythm, frequent premature ventricular beats, Wolff-Parkinson-White syndrome, complete bundle branch block, myocardial infarction or hypertrophic cardiomyopathy were excluded. A total of 10 360 subjects (4630 males) were recruited.

Interventions: A novel ECG criterion (Northeast China Rural Cardiovascular Health Study (NCRCHS)) composed of different ratios of maximum R wave in lead V₅ or V₆ (R_V5/V6), S wave in lead V₃ (S_V3) and R wave in lead aVL (R_aVL) was proposed and validated using multiple linear regression. Receiver-operating characteristic curves were used to compare the NCRCHS criterion with traditional criteria for LVH detection.

Results: An optimised model (15^*R_aVL+8^*S_V3+7^*R_V5/V6) was constructed (R² 0.192, p<0.001) with the cut-off values of 36.8 mV for males and 26.1 mV for females. The maximum area under the curve was obtained using the NCRCHS criterion (male 0.74, 95% CI 0.73 to 0.75; female 0.73, 95% CI 0.72 to 0.75), followed by Cornell voltage criterion, Sokolow-Lyon criterion, Peguero-Lo Presti criterion, multi-ethnic study of atherosclerosis (MESA)-specific criterion and Syst-Eur voltage criterion. Compared with the Cornell voltage criterion, the NCRCHS criterion had a significantly higher sensitivity for detecting LVH at the same level of specificity (p<0.05).

Conclusions: The NCRCHS criterion significantly improved sensitivity for LVH detection in a general Chinese population, with cut-off values of 36.8 and 26.1 mV for males and females, respectively. This criterion can detect LVH earlier and better and may prevent subsequent cardiovascular diseases.

Keywords: adult cardiology; cardiomyopathy; cardiovascular imaging; hypertension; pacing & electrophysiology.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Bundle-Branch Block
Case-Control Studies
China / epidemiology
Cross-Sectional Studies
Electrocardiography
Female
Humans
Hypertension*
Hypertrophy, Left Ventricular* / diagnosis
Male