Skip to main content
Top
Published in: Journal of Cardiovascular Magnetic Resonance 1/2009

Open Access 01-12-2009 | Research

Electrocardiographic (ECG) criteria for determining left ventricular mass in young healthy men; data from the LARGE Heart study

Authors: Syed M Afzal Sohaib, John R Payne, Rajeev Shukla, Michael World, Dudley J Pennell, Hugh E Montgomery

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2009

Login to get access

Abstract

Background

Doubts remain over the use of the ECG in identifying those with increased left ventricular (LV) mass. This is especially so in young individuals, despite their high prevalence of ECG criteria for LV hypertrophy. We performed a study using cardiovascular magnetic resonance (CMR), which provides an in vivo non-invasive gold standard method of measuring LV mass, allowing accurate assessment of electrocardiography as a tool for defining LV hypertrophy in the young.

Methods and results

Standard 12-lead ECGs were obtained from 101 Caucasian male army recruits aged (mean ± SEM) 19.7 ± 0.2 years. LV mass was measured using CMR. LV mass indexed to body surface area demonstrated no significant correlation with the Cornell Amplitude criteria or Cornell Product for LV hypertrophy. Moderate correlations were seen with the Sokolow-Lyon Amplitude (0.28) and Sokolow-Lyon Product (0.284). Defining LV hypertrophy as a body surface area indexed left ventricular mass of 93 g/m2, calculated sensitivities [and specificities] were as follows; 38.7% [74.3%] for the Sokolow-Lyon criteria, 43.4% [61.4%] for the Sokolow-Lyon Product, 19.4% [91.4%] for Cornell Amplitude, and 22.6% [85.7%] for Cornell Product. These values are substantially less than those reported for older age groups.

Conclusion

ECG criteria for LV hypertrophy may have little value in determining LV mass or the presence of LV hypertrophy in young fit males.
Appendix
Available only for authorised users
Literature
1.
go back to reference Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP: Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990, 322: 1561-1566.CrossRefPubMed Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP: Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990, 322: 1561-1566.CrossRefPubMed
2.
go back to reference Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH: Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med. 1991, 114: 345-352.CrossRefPubMed Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH: Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med. 1991, 114: 345-352.CrossRefPubMed
3.
go back to reference Ghali JK, Liao Y, Simmons B, Castaner A, Cao G, Cooper RS: The prognostic role of left ventricular hypertrophy in patients with or without coronary artery disease. Ann Intern Med. 1992, 117: 831-836.CrossRefPubMed Ghali JK, Liao Y, Simmons B, Castaner A, Cao G, Cooper RS: The prognostic role of left ventricular hypertrophy in patients with or without coronary artery disease. Ann Intern Med. 1992, 117: 831-836.CrossRefPubMed
4.
go back to reference Bolognese L, Dellavesa P, Rossi L, Sarasso G, Bongo AS, Scianaro MC: Prognostic value of left ventricular mass in uncomplicated acute myocardial infarction and one-vessel coronary artery disease. Am J Cardiol. 1994, 73: 1-5. 10.1016/0002-9149(94)90717-X.CrossRefPubMed Bolognese L, Dellavesa P, Rossi L, Sarasso G, Bongo AS, Scianaro MC: Prognostic value of left ventricular mass in uncomplicated acute myocardial infarction and one-vessel coronary artery disease. Am J Cardiol. 1994, 73: 1-5. 10.1016/0002-9149(94)90717-X.CrossRefPubMed
5.
go back to reference Post WS, Levy D: New developments in the epidemiology of left ventricular hypertrophy. Curr Opin Cardiol. 1994, 9: 534-541. 10.1097/00001573-199409000-00006.CrossRefPubMed Post WS, Levy D: New developments in the epidemiology of left ventricular hypertrophy. Curr Opin Cardiol. 1994, 9: 534-541. 10.1097/00001573-199409000-00006.CrossRefPubMed
6.
go back to reference Levy D, Labib SB, Anderson KM, Christiansen JC, Kannel WB, Castelli WP: Determinants of sensitivity and specificity of electrocardiographic criteria for left ventricular hypertrophy. Circulation. 1990, 81: 815-820.CrossRefPubMed Levy D, Labib SB, Anderson KM, Christiansen JC, Kannel WB, Castelli WP: Determinants of sensitivity and specificity of electrocardiographic criteria for left ventricular hypertrophy. Circulation. 1990, 81: 815-820.CrossRefPubMed
7.
go back to reference Messerli FH, Aepfelbacher FC: Hypertension and left-ventricular hypertrophy. Cardiol Clin. 1995, 13: 549-557.PubMed Messerli FH, Aepfelbacher FC: Hypertension and left-ventricular hypertrophy. Cardiol Clin. 1995, 13: 549-557.PubMed
8.
go back to reference Devereux RB, Koren MJ, de SG, Okin PM, Kligfield P: Methods for detection of left ventricular hypertrophy: application to hypertensive heart disease. Eur Heart J. 1993, 14 (Suppl D): 8-15.CrossRefPubMed Devereux RB, Koren MJ, de SG, Okin PM, Kligfield P: Methods for detection of left ventricular hypertrophy: application to hypertensive heart disease. Eur Heart J. 1993, 14 (Suppl D): 8-15.CrossRefPubMed
9.
go back to reference Edhouse J, Thakur RK, Khalil JM: ABC of clinical electrocardiography. Conditions affecting the left side of the heart. BMJ. 2002, 324: 1264-1267. 10.1136/bmj.324.7348.1264.PubMedCentralCrossRefPubMed Edhouse J, Thakur RK, Khalil JM: ABC of clinical electrocardiography. Conditions affecting the left side of the heart. BMJ. 2002, 324: 1264-1267. 10.1136/bmj.324.7348.1264.PubMedCentralCrossRefPubMed
10.
go back to reference Sharma S, Whyte G, Elliott P, Padula M, Kaushal R, Mahon N, McKenna WJ: Electrocardiographic changes in 1000 highly trained junior elite athletes. Br J Sports Med. 1999, 33: 319-324. 10.1136/bjsm.33.5.319.PubMedCentralCrossRefPubMed Sharma S, Whyte G, Elliott P, Padula M, Kaushal R, Mahon N, McKenna WJ: Electrocardiographic changes in 1000 highly trained junior elite athletes. Br J Sports Med. 1999, 33: 319-324. 10.1136/bjsm.33.5.319.PubMedCentralCrossRefPubMed
11.
go back to reference Somauroo JD, Pyatt JR, Jackson M, Perry RA, Ramsdale DR: An echocardiographic assessment of cardiac morphology and common ECG findings in teenage professional soccer players: reference ranges for use in screening. Heart. 2001, 85: 649-654. 10.1136/heart.85.6.649.PubMedCentralCrossRefPubMed Somauroo JD, Pyatt JR, Jackson M, Perry RA, Ramsdale DR: An echocardiographic assessment of cardiac morphology and common ECG findings in teenage professional soccer players: reference ranges for use in screening. Heart. 2001, 85: 649-654. 10.1136/heart.85.6.649.PubMedCentralCrossRefPubMed
12.
go back to reference Gasperin CA, Germiniani H, Facin CR, Souza AM, Cunha CL: An analysis of electrocardiographic criteria for determining left ventricular hypertrophy. Arq Bras Cardiol. 2002, 78: 59-82. 10.1590/S0066-782X2002000100006.CrossRefPubMed Gasperin CA, Germiniani H, Facin CR, Souza AM, Cunha CL: An analysis of electrocardiographic criteria for determining left ventricular hypertrophy. Arq Bras Cardiol. 2002, 78: 59-82. 10.1590/S0066-782X2002000100006.CrossRefPubMed
13.
go back to reference Schillaci G, Verdecchia P, Borgioni C, Ciucci A, Guerrieri M, Zampi I, Battistelli M, Bartoccini C, Porcellati C: Improved electrocardiographic diagnosis of left ventricular hypertrophy. Am J Cardiol. 1994, 74: 714-719. 10.1016/0002-9149(94)90316-6.CrossRefPubMed Schillaci G, Verdecchia P, Borgioni C, Ciucci A, Guerrieri M, Zampi I, Battistelli M, Bartoccini C, Porcellati C: Improved electrocardiographic diagnosis of left ventricular hypertrophy. Am J Cardiol. 1994, 74: 714-719. 10.1016/0002-9149(94)90316-6.CrossRefPubMed
14.
go back to reference Norman JE, Levy D: Improved electrocardiographic detection of echocardiographic left ventricular hypertrophy: results of a correlated data base approach. J Am Coll Cardiol. 1995, 26: 1022-1029. 10.1016/0735-1097(95)00269-5.CrossRefPubMed Norman JE, Levy D: Improved electrocardiographic detection of echocardiographic left ventricular hypertrophy: results of a correlated data base approach. J Am Coll Cardiol. 1995, 26: 1022-1029. 10.1016/0735-1097(95)00269-5.CrossRefPubMed
15.
go back to reference Norman JE, Levy D, Campbell G, Bailey JJ: Improved detection of echocardiographic left ventricular hypertrophy using a new electrocardiographic algorithm. J Am Coll Cardiol. 1993, 21: 1680-1686.CrossRefPubMed Norman JE, Levy D, Campbell G, Bailey JJ: Improved detection of echocardiographic left ventricular hypertrophy using a new electrocardiographic algorithm. J Am Coll Cardiol. 1993, 21: 1680-1686.CrossRefPubMed
16.
go back to reference Okin PM, Roman MJ, Devereux RB, Kligfield P: Electrocardiographic identification of increased left ventricular mass by simple voltage-duration products. J Am Coll Cardiol. 1995, 25: 417-423. 10.1016/0735-1097(94)00371-V.CrossRefPubMed Okin PM, Roman MJ, Devereux RB, Kligfield P: Electrocardiographic identification of increased left ventricular mass by simple voltage-duration products. J Am Coll Cardiol. 1995, 25: 417-423. 10.1016/0735-1097(94)00371-V.CrossRefPubMed
17.
go back to reference Raskoff WJ, Goldman S, Cohn K: The "athletic heart". Prevalence and physiological significance of left ventricular enlargement in distance runners. JAMA. 1976, 236: 158-162. 10.1001/jama.236.2.158.CrossRefPubMed Raskoff WJ, Goldman S, Cohn K: The "athletic heart". Prevalence and physiological significance of left ventricular enlargement in distance runners. JAMA. 1976, 236: 158-162. 10.1001/jama.236.2.158.CrossRefPubMed
18.
go back to reference Myerson SG, Bellenger NG, Pennell DJ: Assessment of left ventricular mass by cardiovascular magnetic resonance. Hypertension. 2002, 39: 750-755. 10.1161/hy0302.104674.CrossRefPubMed Myerson SG, Bellenger NG, Pennell DJ: Assessment of left ventricular mass by cardiovascular magnetic resonance. Hypertension. 2002, 39: 750-755. 10.1161/hy0302.104674.CrossRefPubMed
19.
go back to reference ellenger NG, Burgess MI, Ray SG, Lahiri A, Coats AJ, Cleland JG, Pennell DJ: Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance; are they interchangeable?. Eur Heart J. 2000, 21: 1387-1396. 10.1053/euhj.2000.2011.CrossRef ellenger NG, Burgess MI, Ray SG, Lahiri A, Coats AJ, Cleland JG, Pennell DJ: Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance; are they interchangeable?. Eur Heart J. 2000, 21: 1387-1396. 10.1053/euhj.2000.2011.CrossRef
20.
go back to reference Alfakih K, Walters K, Jones T, Ridgway J, Hall AS, Sivananthan M: New gender-specific partition values for ECG criteria of left ventricular hypertrophy: recalibration against cardiac MRI. Hypertension. 2004, 44: 175-179. 10.1161/01.HYP.0000135249.66192.30.CrossRefPubMed Alfakih K, Walters K, Jones T, Ridgway J, Hall AS, Sivananthan M: New gender-specific partition values for ECG criteria of left ventricular hypertrophy: recalibration against cardiac MRI. Hypertension. 2004, 44: 175-179. 10.1161/01.HYP.0000135249.66192.30.CrossRefPubMed
21.
go back to reference Carlsson MB, Trägårdh E, Engblom H, Hedström E, Wagner G, Pahlm O, Arheden H: Left ventricular mass by 12-lead electrocardiogram in healthy subjects: comparison to cardiac magnetic resonance imaging. J Electrocardiol. 2006, 39: 67-72. 10.1016/j.jelectrocard.2005.07.005.CrossRefPubMed Carlsson MB, Trägårdh E, Engblom H, Hedström E, Wagner G, Pahlm O, Arheden H: Left ventricular mass by 12-lead electrocardiogram in healthy subjects: comparison to cardiac magnetic resonance imaging. J Electrocardiol. 2006, 39: 67-72. 10.1016/j.jelectrocard.2005.07.005.CrossRefPubMed
22.
go back to reference Sokolow M, Lyon TP: The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. 1949. Ann Noninvasive Electrocardiol. 2001, 6: 343-368. 10.1111/j.1542-474X.2001.tb00129.x.CrossRefPubMed Sokolow M, Lyon TP: The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. 1949. Ann Noninvasive Electrocardiol. 2001, 6: 343-368. 10.1111/j.1542-474X.2001.tb00129.x.CrossRefPubMed
23.
go back to reference Casale PN, Devereux RB, Kligfield P, Eisenberg RR, Miller DH, Chaudhary BS, Phillips MC: Electrocardiographic detection of left ventricular hypertrophy: development and prospective validation of improved criteria. J Am Coll Cardiol. 1985, 6: 572-580.CrossRefPubMed Casale PN, Devereux RB, Kligfield P, Eisenberg RR, Miller DH, Chaudhary BS, Phillips MC: Electrocardiographic detection of left ventricular hypertrophy: development and prospective validation of improved criteria. J Am Coll Cardiol. 1985, 6: 572-580.CrossRefPubMed
24.
go back to reference Molloy TJ, Okin PM, Devereux RB, Kligfield P: Electrocardiographic detection of left ventricular hypertrophy by the simple QRS voltage-duration product. J Am Coll Cardiol. 1992, 20: 1180-1186.CrossRefPubMed Molloy TJ, Okin PM, Devereux RB, Kligfield P: Electrocardiographic detection of left ventricular hypertrophy by the simple QRS voltage-duration product. J Am Coll Cardiol. 1992, 20: 1180-1186.CrossRefPubMed
25.
go back to reference Payne JR, Eleftheriou KI, James LE, Hawe E, Mann J, Stronge A, Kotwinski P, World M, Humphries SE, Pennell DJ, Montgomery HE: Left ventricular growth response to exercise and cigarette smoking: data from LARGE Heart. Heart. 2006, 92: 1784-1788. 10.1136/hrt.2006.088294.PubMedCentralCrossRefPubMed Payne JR, Eleftheriou KI, James LE, Hawe E, Mann J, Stronge A, Kotwinski P, World M, Humphries SE, Pennell DJ, Montgomery HE: Left ventricular growth response to exercise and cigarette smoking: data from LARGE Heart. Heart. 2006, 92: 1784-1788. 10.1136/hrt.2006.088294.PubMedCentralCrossRefPubMed
26.
go back to reference Bellenger NG, Davies LC, Francis JM, Coats AJ, Pennell DJ: Reduction in sample size for studies of remodeling in heart failure by the use of cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2000, 2: 271-278. 10.3109/10976640009148691.CrossRefPubMed Bellenger NG, Davies LC, Francis JM, Coats AJ, Pennell DJ: Reduction in sample size for studies of remodeling in heart failure by the use of cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2000, 2: 271-278. 10.3109/10976640009148691.CrossRefPubMed
27.
go back to reference Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P: Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings. Circulation. 1987, 75: 565-572.CrossRefPubMed Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P: Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings. Circulation. 1987, 75: 565-572.CrossRefPubMed
28.
go back to reference Alfakih K, Plein S, Thiele H, Jones T, Ridgway JP, Sivananthan MU: Normal human left and right ventricular dimensions for MRI as assessed by turbo gradient echo and steady-state free precession imaging sequences. J Magn Reson Imaging. 2003, 17: 323-329. 10.1002/jmri.10262.CrossRefPubMed Alfakih K, Plein S, Thiele H, Jones T, Ridgway JP, Sivananthan MU: Normal human left and right ventricular dimensions for MRI as assessed by turbo gradient echo and steady-state free precession imaging sequences. J Magn Reson Imaging. 2003, 17: 323-329. 10.1002/jmri.10262.CrossRefPubMed
29.
go back to reference Maceira AM, Prasad SK, Khan M, Pennell DJ: Normalized left ventricular systolic and diastolic function by steady state free precession cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2006, 8: 417-426. 10.1080/10976640600572889.CrossRefPubMed Maceira AM, Prasad SK, Khan M, Pennell DJ: Normalized left ventricular systolic and diastolic function by steady state free precession cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2006, 8: 417-426. 10.1080/10976640600572889.CrossRefPubMed
30.
go back to reference Sokolow M, Freidlander RD: The normal unipolar precordial and limb lead electrocardiogram. Am Heart J. 1949, 38: 665-687. 10.1016/0002-8703(49)90525-6.CrossRefPubMed Sokolow M, Freidlander RD: The normal unipolar precordial and limb lead electrocardiogram. Am Heart J. 1949, 38: 665-687. 10.1016/0002-8703(49)90525-6.CrossRefPubMed
31.
go back to reference Rautaharju PM, Park LP, Gottdiener JS, Siscovick D, Boineau R, Smith V, Powe NR: Race- and sex-specific ECG models for left ventricular mass in older populations. Factors influencing overestimation of left ventricular hypertrophy prevalence by ECG criteria in African-Americans. J Electrocardiol. 2000, 33: 205-218. 10.1054/jelc.2000.7667.CrossRefPubMed Rautaharju PM, Park LP, Gottdiener JS, Siscovick D, Boineau R, Smith V, Powe NR: Race- and sex-specific ECG models for left ventricular mass in older populations. Factors influencing overestimation of left ventricular hypertrophy prevalence by ECG criteria in African-Americans. J Electrocardiol. 2000, 33: 205-218. 10.1054/jelc.2000.7667.CrossRefPubMed
Metadata
Title
Electrocardiographic (ECG) criteria for determining left ventricular mass in young healthy men; data from the LARGE Heart study
Authors
Syed M Afzal Sohaib
John R Payne
Rajeev Shukla
Michael World
Dudley J Pennell
Hugh E Montgomery
Publication date
01-12-2009
Publisher
BioMed Central
Published in
Journal of Cardiovascular Magnetic Resonance / Issue 1/2009
Electronic ISSN: 1532-429X
DOI
https://doi.org/10.1186/1532-429X-11-2

Other articles of this Issue 1/2009

Journal of Cardiovascular Magnetic Resonance 1/2009 Go to the issue