Clinical InvestigationCongestive Heart FailureDiagnostic and prognostic utility of electrocardiography for left ventricular hypertrophy defined by magnetic resonance imaging in relationship to ethnicity: The Multi-Ethnic Study of Atherosclerosis (MESA)
Section snippets
Study sample and traditional risk factor measurements
MESA is a prospective longitudinal study initiated in July 2000 to explore the prevalence, correlates, and progression of subclinical cardiovascular disease (CVD) in a population-based multiethnic cohort free of clinically recognized CVD at enrollment, and selected from 6 US participating field centers. The study objectives, design, and methods have been previously reported.14Hypertension was defined according to the Joint National Committee VI (1997) criteria as diastolic blood pressure ≥90 mm
Study sample and baseline characteristics
The study sample consisted of 4,967 participants (2,365 men [47.6%], mean age 61.5 ± 10.1 years) (Table I). The ethnicity of the study sample was 38.8% whites, 13.2% Chinese, 25.7% African Americans, and 22.3% Hispanics. Three hundred eighty-four (7.7%) of 4,967 participants had LVH on MRI.
Overall diagnostic performance of ECG-LVH measures against MRI-LVH
Sensitivity, specificity, and area under the curve (AUC) of traditional ECG-LVH measures to detect MRI-LVH ranged from 5.7% to 26.0%, 88.7% to 99.2%, and 0.52 to 0.59, respectively. All criteria showed a
Discussion
In this study, we assessed the diagnostic and prognostic utility of standard ECG measures of LVH in a large multiethnic sample using cardiac MRI to quantify LV mass. We found that commonly used ECG-LVH criteria show a low overall sensitivity that varied by ethnicity, a high specificity, and overall low diagnostic performance in diagnosing LVH as defined by MRI. This finding is consistent with previous studies that have also shown ECG to be typically insensitive and highly specific in detecting
Conclusions
Although ECG has a low sensitivity to diagnose MRI-defined LVH, the standard ECG is the first-line investigation for suspected LVH in view of its simplicity, widespread availability, and low cost. The performance of ECG for LVH detection varies substantially by ethnicity, with the African American subgroup showing higher overall performance compared with other ethnic groups. Our results from a multiethnic study population suggest that alternative ECG criteria may improve detection of LVH. Most
Disclosures
There are no conflicts of interest and financial disclosures for any of the authors.
Acknowledgements
The authors thank other investigators, staff, and participants of the MESA Study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org.
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