Background Left ventricular hypertrophy (LVH) is a marker of cardiac end‐organ damage and a risk factor for cardiovascular morbidity and mortality. Although clinical trials and cohort studies commonly use the electrocardiogram (ECG) for LVH assessment, the repeatability of ECG‐LVH criteria has not been sufficiently examined. Therefore, we evaluated the repeatability of ECG‐LVH criteria. Methods Participants (n = 63) underwent two standard ECGs at each of two visits, two weeks apart. The ECGs were processed centrally to calculate Cornell voltage (CV) LVH, Cornell voltage product (CVP) LVH, Sokolow–Lyon (SL) LVH, and Sokolow–Lyon product (SLP) LVH. We also used the waveforms measurements contributing to these LVH criteria as continuous variables, referred to here as CV‐index, CVP‐index, and SL‐index. We calculated the intraclass correlation coefficient (ICC), minimal detectable change (95% confidence), and the prevalence‐adjusted bias‐adjusted kappa (PABAK). Results ICCs (95% confidence intervals (CI)) were 0.97 (0.96, 0.98) for CV‐index, 0.97 (0.95, 0.98) for CVP‐index, and 0.93 (0.90, 0.96) for log of SL‐index. Minimal detectable change between repeat measures of CV‐index, CVP‐index, and log of SL‐index were ≥236.7 mV, ≥26.7 mV, and ≥0.09 mV, respectively. The within‐visit PABAK was 1 for all ECG‐LVH criteria, except for the first visit SLP‐LVH (PABAK = 0.93). Between‐visit PABAK ranged from 0.83 to 0.97 across LVH criteria. Conclusions CV, CVP, and SL ECG‐LVH as continuous variables have excellent repeatability, and as binary variables have excellent within‐visit agreement and good between‐visit agreement. These results alleviate concerns about the repeatability the ECG‐LVH use in clinical trials and epidemiologic studies.
Background: Electrocardiographic left ventricular hypertrophy (ECG-LVH) represents preclinical cardiovascular disease and predicts cardiovascular disease morbidity and mortality. While the newly developed Peguero-Lo Presti ECG-LVH criteria have greater sensitivity for LVH than the Cornell voltage and Sokolow-Lyon criteria, its short-term repeatability is unknown. Therefore, we characterized the short-term repeatability of Peguero-Lo Presti ECG-LVH criteria and evaluate its agreement with Cornell voltage and Sokolow-Lyon ECG-LVH criteria.Methods: Participants underwent two resting, standard, 12-lead ECGs at each of two visits one week apart (n = 63). We defined a Peguero-Lo Presti index as a sum of the deepest S wave amplitude in any single lead and lead V 4 (i.e., S D + SV 4 ) and defined Peguero-Lo Presti LVH index as ≥ 2,300 µV among women and ≥ 2,800 µV among men. We estimated repeatability as an intraclass correlation coefficient (ICC), agreement as a prevalence-adjusted bias-adjusted kappa coefficient (κ), and precision using 95% confidence intervals (CIs). Results:The Peguero-Lo Presti index was repeatable: ICC (95% CI) = 0.94 (0.91-0.97).Within-visit agreement of Peguero-Lo Presti LVH was high at the first and second visits: κ (95% CI) = 0.97 (0.91-1.00) and 1.00 (1.00-1.00). Between-visit agreement of the first and second measurements at each visit was comparable: κ (95% CI) = 0.90 (0.80-1.00) and 0.93 (0.85-1.00). Agreement of Peguero-Lo Presti and Cornell or Sokolow-Lyon LVH on any one of the four ECGs was slightly lower: κ (95% CI) = 0.71 (0.54-0.89). Conclusion:The Peguero-Lo Presti index and LVH have excellent repeatability and agreement, which support their use in clinical and epidemiological studies.
Background: Left ventricular hypertrophy (LVH) is a marker of cardiac end-organ damage and a risk factor for cardiovascular morbidity and mortality. Although electrocardiogram (ECG) is the most common tool for LVH assessment in contemporary clinical trials and cohort studies, the repeatability of ECG-LVH criteria has not been sufficiently examined. Objectives: Characterize the repeatability and minimal detectable change of ECG-LVH criteria. Methods: A total of 63 participants (mean age 50 years; 31 females) underwent two visits one week apart. At each visit, two digital ECGs were obtained following a standardized protocol. The ECG data were processed centrally to automatically obtain waveform measurements needed to calculate Cornell voltage (CV) LVH (SV3 + RaVL >2800 μV for men and >2000 μV for women), Cornell voltage product (CVP) LVH ((RaVL + SV3) X QRS duration ≥244 mV sec; for both Cornell criteria, 0.8 mV was added to the voltage sum for women), and Sokolow-Lyon (SL) LVH (SV1 +RV5/V6 ≥3500 μV). In addition to using these criteria as dichotomous LVH variables, we also used the waveforms measurements composing them as continuous variables, referred to here as CV-index, CVP-index, and SL-index. We used random-effects, mixed models to parse the variance of the variables into their between-participant, between-visit, and within-visit components, and calculated the intra-class correlation coefficient (ICC), minimal detectable change (95% confidence), and Kappas. Results: Between-participant variation accounted for 93% to 97% of the total variation in CV-index, CVP-index, and log of SL-index. The ICCs (95% confidence intervals) were 0.97 (0.96, 0.98) for CV-index, 0.97 (0.95, 0.98) for CVP-index, and 0.93 (0.90, 0.96) for log of SL-index. Minimal detectable change between repeat measures of CV-index, CVP-index, and log of SL-index were ≥236.7 μV, ≥26.7 mV, and ≥0.09 μV, respectively. The within-visit Kappa (95% confidence limits) was 0.73 (0.38, 1.00) for SL LVH and 1 for the other two LVH criteria. The between-visit Kappa was 1 for CV LVH, 0.66 (0.04, 1.00) for CVP LVH, and 0.40 (-0.03, 0.83) and 0.64 (0.26, 1.00) for the SL LVH first and second measurements of each visit, respectively. When defining ECG-LVH as presence of ≥1 ECG-LVH criteria, the within visit Kappa became 0.78 (0.49, 1.00) for the first visit and 1 for the second visit; the between visit Kappa values became 0.50 (0.12, 0.88) and 0.70 (0.38, 1.00) for the first and second measurements of each visit. Conclusion: CV, CVP, SL indices as continuous variables have excellent repeatability. The dichotomous ECG-LVH criteria have excellent within visit agreement, but between visit agreement ranges from fair to poor, which improved by combining multiple criteria. These results alleviate concerns about the repeatability the ECG LVH use in clinical trials and epidemiologic studies.
Background: Electrocardiographic left ventricular hypertrophy (ECG-LVH) represents preclinical cardiovascular disease and predicts cardiovascular disease and mortality. Current criteria include the Cornell voltage, Sokolow-Lyon, and the newly developed Peguero index (S D + SV 4 ). While the Peguero index has been shown to have better prognostic prediction compared with current criteria, its short term repeatability remains uncertain. Objectives: Characterize the repeatability and minimal detectable change of the Peguero ECG-LVH index. Methods: Participants (n=63; mean age 50 years; 31 females) underwent two standardized visits one week apart. At each visit, trained and certified technicians obtained two ECGs following a standardized protocol. The Epidemiological Cardiology Research Center automatically processed the ECGs using GE Marquette GE 12-SL software (GE, Milwaukee, WI) to obtain the Peguero (S D + SV 4 ) LHV index, defined as the deepest S wave in any single lead S D + SV 4 . We created a dichotomous using the following cut points: >2.3 mV for women and >2.8 mV for men. Random effects, mixed models were used to parse the variance of the index into the between-participant, between-visit, and within-visit components. We then calculated the intra-class correlation coefficient (ICC), Kappa coefficients, and minimal detectable change (95% confidence) between repeat measures. Results: Between-participant variation accounted for 93.58% (262,958 out of 280,985 SD points) of the total variation of the Peguero LVH index, while between-visit variation and within-visit variation were 5.51% (15,480 out of 280,985 SD points) and 0.91% (2,547 out of 280,985 SD points), respectively. The index had an ICC (95% confidence interval) of 0.94 (0.91-0.97) and a minimum detectable change value of 372.16 mV. Within visit Kappas were 0.79 (0.40-1.00) for the first visit and 1.00 (1.00-1.00) for the second visit. Between visit Kappas were 0.77 (0.70-0.84) for the first measurements of each visit and 0.79 (0.72-0.86) for the second measurements of each visit. Conclusion: The Peguero LVH index shows excellent repeatability for both within and between visits. The ICC and resulting confidence interval of the continuous index suggests near perfect agreement between groups. The Kappa values also suggest concurrence between groups of the dichotomous index, although the measures are not as precise as the ICC measure. The repeatability of this measure can be used to inform clinical and epidemiological studies and expand research of this novel index of ECG-LVH.
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