Can left ventricular hypertrophy on electrocardiography detect severe aortic valve stenosis?

Abstract

Background Severe aortic stenosis (AS) is increasing in the aging society and is a serious condition for anesthetic management. However, approximately one-third of patients with severe AS are asymptomatic. Echocardiography is the most reliable method to detect AS, but it takes time and is costly. Methods Data were obtained retrospectively from patients who underwent surgery and preoperative transthoracic echocardiography (TTE). LVH on ECG was determined by voltage criteria (Sv 1 + Rv 5 or 6 ≥3.5 mV) and/or the strain pattern in V 5 and V 6 . Severe AS was defined as a mean transaortic pressure gradient ≥40 mmHg or aortic valve area ≤1.0 cm 2 by TTE. Results Data for 470 patients aged 28–94 years old were obtained. One hundred and twenty-six patients had severe AS. LVH on ECG by voltage criteria alone was detected in 182 patients, LVH by strain pattern alone was detected in 80 patients and LVH by both was detected in 55 patients. Multivariable logistic analysis revealed that LVH by the strain pattern or voltage criteria, diabetes mellitus, and age were significantly associated with severe AS. The AUC for the ROC curve for LVH by voltage criteria alone was 0.675 and the cut-off value was 3.84 mm V, and the AUC for the ROC for age was 0.675 and the cut-off value was 74 years old. Conclusion Our study suggests that patients who are 74 years old or over with LVH on ECG, especially those with DM, should undergo preoperative TTE in order to detect severe AS.

Salt intake causes B-type natriuretic peptide elevation independently of blood pressure elevation in the general population without hypertension and heart disease

“…However, ECG voltage criteria (SV1 + RV5 ≥ 3.5 mV) is confirmed to determine LVH. [ 3 , 15 ] Therefore, we used the levels of SV1 + RV5 to exclude the participants with LVH in this study.…”

“…In addition, it has not been completely determined whether the levels of SV1 + RV5 in normal ranges can be used as the marker of left ventricular thickness. However, ECG voltage criteria (SV1 + RV5 ≥ 3.5 mV) is confirmed to determine LVH [3,15] . Therefore, we used the levels of SV1 + RV5 to exclude the participants with LVH in this study.…”

“…Left ventricular hypertrophy (LVH) on ECG was determined by Sokolow-Lyon voltage criteria (SV1 + RV5 ≥ 3.5 mV) and was assessed as one of the cardiovascular risk factors, as described previously. [ 3 , 15 ] Hypertension and ECG abnormalities, including LVH and arrhythmia such as atrial fibrillation, may influence BNP levels and lead to a poor prognosis of heart diseases. [ 9 ] Therefore, we excluded the participants with hypertension and or abnormality of ECG and performed the statistical analysis using 1404 participants.…”

“…Voltage in the 12-lead ECG was defined by the following: an S-wave in V1 plus an R-wave in V5 wave (SV1 + RV5). Left ventricular hypertrophy (LVH) on ECG was determined by Sokolow-Lyon voltage criteria (SV1 + RV5 ≥ 3.5 mV) and was assessed as one of the cardiovascular risk factors, as described previously [3,15] . Hypertension and ECG abnormalities, including LVH and arrhythmia such as atrial fibrillation, may influence BNP levels and lead to a poor prognosis of heart diseases [9] .…”

Identifying Obstructive Hypertrophic Cardiomyopathy from Nonobstructive Hypertrophic Cardiomyopathy: Development and Validation of a Model Based on Electrocardiogram Features

“…Similarly, it has also been reported that the AUC of the ROC curve for left ventricular hypertrophy by the ECG voltage criteria alone was only 0.675 [29]. It suggested a 'possibly helpful' discrimination ability (AUC: 0.60-0.75) for severe aortic stenosis (AS) detection according to the guides of discrimination and calibration of clinical prediction models [21].…”