Experimental Biology 2010: A Comparative Study Between 18 Electrocardiographic Criteria For Prediction Of Left Ventricular Hypertrophy In Caucasians And African Americans Using Cardiac Mri

Purpose of Study: Electrocardiographic (ECG) criteria for prediction of left ventricular hypertrophy (LVH) have been developed and validated largely in Caucasian individuals using postmortem heart or echocardiogram. We sought to determine the accuracy of these ECG criteria for detection of LVH in both races using cardiac magnetic resonance (cMR) as standard.

Methods Used: cMR and ECG evaluations were performed in 193 AA (57.7 ± 16.8 yrs) and 133 Caucasians (62.6 ± 16.9 yrs) who had both an ECG and cMR within 6 months Ventricular mass was determined by cMR (1.5 T GE) using a FIESTA protocol with manual endocardial and epicardial border tracing. LV mass was adjusted for subjects body surface area using Dubios formula. LVH was defined as a LVM index > 95 g/m2. 18 ECG criteria were compared using chi square and receiver operator curves (ROC).

Summary of Results: Cornell voltage criterion showed the highest sensitivity for detection of LVH in Caucasians followed by Wolff, Goodwin and Lepeschkin criteria with predictive value of 49.7%, 48.6%, 39.9% and 39.3% respectively. However, Wolff criterion showed the highest sensitivity in AA, followed by Cornell, Lepeschkin and Goodwin criteria with 51.8%, 50.8%, 43.2 and 41.5%, respectively. McPhie and Wilsons with 99.3% and 98.6% predictive value were the most specific criteria in Caucasians and AA, respectively. However, their sensitivity in both races was ranked among the lowest (8.2% and 4.9% in Caucasians and 10.1% and 5.9% in AA, respectively).
In the combined analysis for both races, Cornell criterion with predictive value 47.7% was the most sensitive criterion. The ROC analyses revealed that Cornell Criteria had the largest area under the curve (AUC) in both Caucasians and AA (0.676 and 0.655 respectively) as compared to the other ECG criteria.

Conclusions: Cornell voltage criterion found to have nearly the same and at the same time highest predictive value for detection of LVH among Caucasians and African Americans.