Influence of relative wall thickness on electrocardiographic voltage measures in left ventricular hypertrophy: a novel factor contributing to poor diagnostic accuracy

ABSTRACT

Objective: To characterize the influence of relative wall thickness (RWT) on Cornell, Sokolow-Lyon and Peguero-Lo Presti voltages and elucidate its potential impacts on their diagnostic accuracy for LVH in a large general Chinese population.

Methods: A total of 10,614 permanent residents aged ≥ 35 years were recruited for this study. All the participants were subjected to ECG and echocardiogram during the same visit. Multivariate linear and logistic regression analyzes were conducted to assess the influence of RWT on the voltages and their diagnostic performance for LVH detection.

Results: A distinct correlation was identified between RWT and Cornell and Peguero-Lo Presti voltages following adjustments for age, gender and left ventricular mass (LVM) (β = 0.675 and 1.342, respectively; Ps < 0.001). Besides, subjects with RWT > 0.42 exhibited higher rates of LVH diagnosed by Cornell (OR = 1.78, 95% CI: 1.45–2.20), Sokolow-Lyon (OR = 1.30, 95% CI: 1.08–1.56), and Peguero-Lo Presti voltage (OR = 1.48, 95% CI: 1.29–1.70) after adjustments for age, gender and echocardiographic LVH. Furthermore, concentric remodeling or concentric hypertrophy displayed higher rates of LVH diagnoses via Cornell and Peguero-Lo Presti voltage criteria, as compared with normal geometry or eccentric hypertrophy, respectively (all Ps < 0.05), findings of which were independent of age, gender and LVMI.

Conclusion: Echocardiographic RWT was independently correlated with electrocardiographic voltage measures of LVH, which influenced their positive rates and contributed to poor diagnostic performance.

KEYWORDS:

• Relative wall thickness
• electrocardiography
• left ventricular geometry
• left ventricular hypertrophy

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethics approval and consent to participate

The study was granted approval by the Ethics Committee of China Medical University in Shenyang, China. Written informed consent was obtained from all participants.

Availability of data and materials

The datasets used and analyzed during this study are available from the corresponding author on reasonable request.

Authors’ contributions

Ying-xian Sun was responsible for the concept and design of the study. Ning Ye and Guo-zhe Sun were responsible for the study coordination and conduct. Ning Ye contributed to the manuscript. Ying Zhou and Shao-jun Wu collected and analyzed the data. All authors read and approved the final manuscript.

Declaration of interest

The authors declared they have no competing interests.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This study was funded by the National Science and Technology Support Program of China (Grant #2012BAJ18B08-7) and National Key R&D Program of China (Grant #2017YFC1307600).The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.