ECG Criteria for Left Ventricular Hypertrophy in Hypertensive Black Africans: Insights from the CoArtHA Trial
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Background
Electrocardiographic (ECG) criteria for detecting left ventricular hypertrophy (LVH) were derived largely from non-African populations. Whether these indices accurately identify LVH in African adults with untreated hypertension remains uncertain.
Objective
To evaluate the diagnostic accuracy of established ECG-LVH criteria compared with echocardiographic left ventricular mass index (LVMI) in Black African adults with untreated, uncomplicated hypertension enrolled in the CoArtHA trial.
Methods
In this subanalysis, we included participants from rural Tanzania and Lesotho who underwent baseline 12-lead ECG and focused transthoracic echocardiography (fTTE). LVH was defined as LVMI > 95 g/m² in women and > 115 g/m² in men. Diagnostic performance of multiple ECG-LVH criteria was assessed using Spearman correlation, sensitivity, specificity, and area under the receiver-operating characteristic curve (AUC).
Results
Echocardiographic LVH was present in 56 participants (5%). Among continuous ECG indices, the Cornell voltage product adjusted by + 0.8 mV in women showed the highest correlation with LVMI (rho = 0.373, p < 0.001) and achieved the best overall discrimination (AUC = 0.719). Standard cut-offs provided a specificity of 79.5% and sensitivity of 64.3%, whereas an adapted cut-off of 277.8 mV*ms increased specificity above 90%. Other indices, including MESA- and Sokolow-Lyon-based criteria, showed limited accuracy.
Conclusions
In this large cohort of hypertensive Black African adults, the Cornell voltage product (with + 0.8 mV adjustment for women) demonstrated the best diagnostic performance for detecting LVH compared with echocardiography. These results highlight the need to verify the diagnostic validity of established ECG criteria in African populations and support their pragmatic use to guide cardiovascular risk stratification in low-resource settings.
Trial registration
Clinicaltrials.gov NCT04129840 . Registered on 17 October 2019 ( https://www.clinicaltrials.gov/ ).
