ECG Criteria for Left Ventricular Hypertrophy in Hypertensive Africans
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Background
ECG criteria for detecting left ventricular hypertrophy (LVH) have been established and evaluated in populations with underrepresentation of Africans. We tested accuracy of LVH ECG criteria in a large population of black African adults with untreated, uncomplicated hypertension in comparison to LV mass determined with echocardiography.
Methods
In this subanalysis of the CoArtHA (Identifying most effective Treatment Strategies to Control Arterial Hypertension in sub-Saharan Africa) we analysed the value of different ECG criteria compared to cardiac geometry assessed by echocardiography at baseline. LVH was defined as left ventricular mass indexed to body surface area (LVMI) >95g/m 2 in women, >115g/m 2 in men.
Results
In 1125 treatment-naïve adults with uncomplicated hypertension (median age 53.4□years, 72□% women), echocardiographic LVH was present in 56 (5□%) participants. Strongest correlations with LVMI were observed for Cornell voltage product (rho□=□0.373) and Cornell voltage criteria (rho□=□0.327), all p□<□0.001. Standard cut-offs yielded highest specificity for strain pattern (0.970) and Cornell product (0.923). Among continuous measures, the Cornell voltage product adjusted by +0.8□mV in women achieved the highest AUC (0.719), followed by its unadjusted form (AUC□0.651).
Conclusions
The Cornell voltage product—particularly when adjusted by +0.8□mV in women— demonstrated the best overall diagnostic accuracy (AUC□0.719) for detecting LVH in this rural African hypertensive cohort, despite only moderate correlation with echocardiographic LVMI. Its implementation as a first-line ECG criterion may help to stratify risk and prioritize patients for echocardiography in resource-limited settings.
Trial registration
Clinicaltrials.gov NCT04129840 . Registered on 17 October 2019 ( https://www.clinicaltrials.gov/ ).
Clinical Perspective
– In a large cohort of 1125 untreated black Africans with hypertension, the adjusted Cornell voltage product (+0.8□mV for women) was the most effective at discriminating between cases of echocardiographic left ventricular hypertrophy, outperforming a large number of different standard ECG parameters.
– Using the standard cut-off value of 243.6 mVms was in line with the best Youden index and offered the highest discriminatory properties (sensitivity 64.3%, specifity 79.6%), however, an adapted cut-off value of 277 mVms increased specificity to over 90% at a sensitivity of 42.9%.
– Adopting the adjusted Cornell voltage product in this population could streamline the detection of early left ventricular hypertrophy, enabling the efficient allocation of echocardiographic resources.
