Circulation, Vol 81, 815-820, Copyright © 1990 by American Heart Association
D Levy, SB Labib, KM Anderson, JC Christiansen, WB Kannel and WP Castelli
Numerous electrocardiographic criteria, which are largely dependent on
fixed voltage thresholds, have been proposed for the diagnosis of left
ventricular hypertrophy (LVH). Electrocardiographic criteria for LVH were
examined in 4,684 subjects of the Framingham Heart Study who underwent
echocardiographic study for LVH. Echocardiographic LVH was detected in 290
men (14.2%) and 465 women (17.6%). Electrocardiographic features of LVH
were present in 2.9% of men (60/2,042) and 1.5% of women (39/2,642). The
overall sensitivity of the electrocardiographic diagnosis of LVH was 6.9%,
whereas specificity was 98.8%. Sensitivity of the electrocardiogram (ECG)
for LVH was marginally lower in women than in men (5.6% vs. 9.0%, p =
0.075). Obesity was inversely associated with sensitivity (p less than
0.05, both sexes combined, sex- adjusted). Smoking was also inversely
related to sensitivity (p = 0.001, both sexes combined, sex-adjusted). In
contrast, sensitivity of the ECG increased with age (p less than 0.001,
both sexes combined, sex- adjusted). These findings suggest that
electrocardiographic detection of LVH can be improved by incorporating
information about noncardiac factors that impact on electrocardiographic
sensitivity for LVH, presumably by attenuating QRS voltage. New strategies
that take into consideration sex, age, smoking status, and obesity might
improve the sensitivity of the ECG without diminishing specificity.
ARTICLES
Determinants of sensitivity and specificity of electrocardiographic criteria for left ventricular hypertrophy
Framingham Heart Study, Massachusetts 01701.
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