Does left ventricular hypertrophy by electrocardiogram predict adverse outcomes in pregnancies with chronic hypertension?

Duncan, Jose R.; Macdonald, Erin; Dorsett, Katherine M; Nayyar, Mannu; Bursac, Zoran; Schenone, Mauro

doi:10.1080/14767058.2018.1524457

Cited by 2 publications

(2 citation statements)

References 19 publications

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“… 12 The 2016 Asian Expert Consensus on the Diagnosis and Treatment of Hypertension and Left Ventricular Hypertrophy clearly pointed out that an electrocardiogram is the first choice for screening and diagnosing hypertension and left ventricular hypertrophy. 13 The results of this study showed that, compared with the Control group, patients in the Study group had statistically significant differences in body surface area, heart rate, diastolic blood pressure, systolic blood pressure, left ventricular muscle weight index, left ventricular posterior wall thickness, and interventricular thickness, suggesting that the elderly patients with essential hypertension and LVH may have the basis of abnormal ECG results.…”

Section: Discussionmentioning

confidence: 68%

The Diagnostic Value of the Deepest S Wave in 12-Lead Electrocardiogram to Elderly Patients with Essential Hypertension and Left Ventricular Hypertrophy

Ji¹,

Zhang²,

He³

2022

CIA

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Objective This study aims to explore the diagnostic value of the deepest S wave (S D ) in elderly patients with essential hypertension and left ventricular hypertrophy (LVH). Methods A retrospective study was conducted in elderly patients with essential hypertension from October 2020 to December 2021. The 12-lead electrocardiogram (ECG) examination was carried out at the time of admission. Echocardiography was performed to estimate left ventricular mass (LVM) and the left ventricular muscle mass index (LVMI) was adjusted by the body surface area (BSA). The Receiver Operating Characteristic (ROC) curve for diagnosing hypertension with LVH was drawn, the cut-off value was determined according to the Youden index, and the area under the curve (AUC) was calculated. The diagnostic values of S D , S D +S v4 , r avl +S v3 , and S v1 +R v5 were compared. Results The results of S D , S D +S v4 , R avL +S v3 , and S v1 +R v5 in the Study group were 2.03 (1.56–2.57) mV, 3.09 (2.38–3.98) mV, 2.19 (1.46–2.78) mV, and 3.38 (2.67–4.19) mV respectively, which were all higher than those in the Control group [0.93 (0.68–1.23) mV, 1.37 (1.32–2.18) mV, 1.03 (0.68–1.46) mV, and 2.28 (1.67–2.67) mV], P <0.001. Compared with the ROC curved by S D +S v4 , R avL +S v3 , and S v1 +R v5 , the AUC of the ROC curved by S D was [0.887, 95% CI (0.837–0.927)], and the cut-off value was 1.298 with the Sensitivity = 86.03 and Specificity = 86.59 in diagnosing essential hypertension with LVH. In female patients, the AUC of the ROC curved by S D was [0.891, 95% CI (0.841–0.934)], and the cut-off value was 1.304 with the Sensitivity of 89.32% and Specificity of 88.67%, which were all higher than those in male patients [AUC = 0.887, 95% CI (0.828–0.943); cut-off value = 1.288; Sensitivity = 82.12%, and Specificity = 84.22%]. Conclusion ECG can effectively diagnose elderly patients with essential hypertension and LVH and the diagnostic value of S D and S D +S v4 are higher than the current Cornell criteria and Sokolow–Lyon criteria.

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Section: Discussionmentioning

confidence: 68%

The Diagnostic Value of the Deepest S Wave in 12-Lead Electrocardiogram to Elderly Patients with Essential Hypertension and Left Ventricular Hypertrophy

Ji¹,

Zhang²,

He³

2022

CIA

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“…Of note, a retrospective study of individuals with chronic hypertension showed that individuals who had left ventricular hypertrophy by electrocardiogram compared with those who did not had threefold increased odds of superimposed preeclampsia. 14 It is not clear why left ventricular hypertrophy by electrocardiogram is predictive of superimposed preeclampsia when electrocardiogram is not predictive of left ventricular hypertrophy. Future research studies that evaluate rates of superimposed preeclampsia according to electrocardiogram and echocardiogram would be useful to further clarify the association between left ventricular hypertrophy and superimposed preeclampsia.…”

Section: Research Implicationsmentioning

confidence: 99%

The Role of the Electrocardiogram in Pregnant Individuals with Chronic Hypertension

et al. 2022

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Objective: The American College of Obstetricians and Gynecologists suggests that an electrocardiogram is an acceptable first-line test. We sought to examine whether an electrocardiogram is a sufficient screening tool to identify echocardiogram-diagnosed left ventricular hypertrophy. We also sought to determine risk factors associated with left ventricular hypertrophy. Study Design: This was a retrospective cohort study of pregnant individuals with chronic hypertension who delivered at 20 weeks’ gestation or greater at a tertiary care center. Analyses were limited to individuals who had both electrocardiogram and echocardiogram during pregnancy. Left ventricular hypertrophy was diagnosed using the American Society of Echocardiography guidelines. Maternal demographics and electrocardiogram results were compared between individuals with left ventricular hypertrophy and those without left ventricular hypertrophy. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of the electrocardiogram to identify left ventricular hypertrophy were also calculated. Adjusted odds ratios (aOR) with 95% confidence intervals (95%CI) were calculated, controlling for covariates. Results: Of 172 individuals, 60 (34.9%) had left ventricular hypertrophy. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of the electrocardiogram to identify echocardiogram diagnosed left ventricular hypertrophy was 18.3% (95% confidence interval [CI] 9.5-30.4), 91.1% (95%CI 84.2-95.6), 2.05 (95%CI 0.93-4.56), and 0.90 (95%CI 0.78-1.02), respectively. Compared to individuals without left ventricular hypertrophy, those with left ventricular hypertrophy were more likely to have hypertension of 4 years duration or longer (aOR 4.01; 95%CI 1.71-9.42), unknown duration of hypertension (aOR 4.66; 95%CI 1.28-17.04), and higher body mass index (aOR 1.04; 95%CI 1.01-1.07). After adjusting for covariates, left ventricular hypertrophy by electrocardiogram was not associated with actual left ventricular hypertrophy (aOR 2.59; 95%CI 0.94-7.10). Conclusion: Electrocardiogram was not a sufficient test for identifying left ventricular hypertrophy in pregnant individuals with chronic hypertension. We suggest an echocardiogram evaluation for all individuals with chronic hypertension.

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Does left ventricular hypertrophy by electrocardiogram predict adverse outcomes in pregnancies with chronic hypertension?

Abstract: LVH by ECG criteria may be associated with higher rates of SIP and with lower birthweight in pregnancies with CHTN. ECG may be a cost-effective tool to identify patients with CHTN at risk of adverse outcomes. Larger trials are necessary to corroborate our findings.

Cited by 2 publications

References 19 publications

The Diagnostic Value of the Deepest S Wave in 12-Lead Electrocardiogram to Elderly Patients with Essential Hypertension and Left Ventricular Hypertrophy

The Diagnostic Value of the Deepest S Wave in 12-Lead Electrocardiogram to Elderly Patients with Essential Hypertension and Left Ventricular Hypertrophy

The Role of the Electrocardiogram in Pregnant Individuals with Chronic Hypertension

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