Factors associated with diagnostic discrepancy for left ventricular hypertrophy between electrocardiography and echocardiography

Figures & data

Figure 1. Flowchart showing the study population selection.

Table 1. Baseline characteristics according to LVH categories.

Variable	All subjects (n = 1382)	No LVH (n = 1058)	LVH verified by ECG, but not echocardiography (n = 84)	LVH verified by echocardiography, but not ECG (n = 173)	LVH on both ECG and echocardiography (n = 67)	p value for difference between categories
Age	67 (61–70)	66 (60–70)	68 (63–74)	69 (65–74)	68 (66–74)	<.0001§
Male sex (%)	947 (69%)	757 (72%)	56 (67%)	98 (57%)	36 (54%)	<.0001*
Active smoking (%)	205 (15%)	158 (15%)	9 (11%)	30 (17%)	8 (12%)	.49*
Use of antihypertensive medication (%)	568 (41%)	407 (39%)	35 (42%)	96 (56%)	30 (45%)	<.0001*
Angiotensin-converting-enzyme inhibitor (%)	266 (19%)	194 (18%)	14 (17%)	46 (27%)	12 (18%)	.07*
Beta blocker (%)	259 (19%)	178 (17%)	13 (16%)	50 (29%)	18 (27%)	.0005*
Calcium channel blocker (%)	125 (9%)	92 (9%)	8 (10%)	16 (9%)	9 (13%)	.62*
Diuretic (%)	78 (6%)	49 (5%)	5 (6%)	15 (9%)	9 (13%)	.005*
Waist circumference (cm)	98 ± 12	98 ± 12	95 ± 11	100 ± 13	96 ± 13	.03^†
Hip circumference (cm)	104 ± 8	103 ± 8	103 ± 8	106 ± 9	105 ± 10	.001†
Height (cm)	172 ± 9	172 ± 9	172 ± 9	169 ± 10	170 ± 9	.0005†
Weight (kg)	83 ± 14	83 ± 14	81 ± 13	84 ± 15	82 ± 15	.38†
Body surface area (m^2)	1.94 ± 0.19	1.95 ± 0.19	1.93 ± 0.17	1.92 ± 0.20	1.92 ± 0.20	.22†
Body mass index (kg/m^2)	28.1 ± 4.3	27.9 ± 4.1	27.4 ± 3.9	29.3 ± 4.7	28.2 ± 5.2	.0003†
Obese (body mass index ≥30 kg/m^2) (%)	389 (28%)	284 (27%)	19 (23%)	65 (38%)	21 (31%)	.02*
Systolic blood pressure (mm Hg)	148 ± 20	146 ± 19	154 ± 22	153 ± 20	154 ± 23	<.0001†
Diastolic blood pressure (mm Hg)	85 ± 10	85 ± 10	85 ± 11	87 ± 10	86 ± 13	.09†
Heart rate (beats per minute)	72 ± 12	73 ± 12	71 ± 12	71 ± 12	67 ± 11	.002†
Fasting plasma glucose (mmol/L)	6.2 (5.5–7.2)	6.2 (5.5–7.2)	6.2 (5.6–7.6)	6.4 (5.8–7.6)	6.4 (5.4–7.1)	.12§
Normal fasting glucose (%)	544 (39%)	423 (40%)	35 (42%)	60 (35%)	26 (39%)	.43*
Impaired fasting glucose (%)	396 (29%)	309 (29%)	18 (21%)	48 (28%)	21 (31%)	–
Diabetes mellitus (%)	442 (32%)	326 (31%)	31 (37%)	65 (38%)	20 (30%)	–
Total cholesterol (mmol/L)	5.6 ± 1.1	5.6 ± 1.1	5.5 ± 1.1	5.5 ± 1.0	5.6 ± 1.1	.84†
Low-density lipoprotein cholesterol (mmol/L)	3.6 ± 1.0	3.6 ± 1.0	3.6 ± 1.0	3.5 ± 0.9	3.6 ± 1.0	.80†
Sokolow-Lyon voltage combination (mm)	22 ± 7	21 ± 6	27 ± 9	22 ± 6	29 ± 10	<.0001†
Cornell voltage-duration product (mm x ms)	1534 ± 624	1376 ± 470	2312 ± 804	1665 ± 456	2705 ± 805	<.0001†
Left ventricular mass (g)	172 ± 48	159 ± 36	168 ± 34	229 ± 47	247 ± 63	<.0001†
Left ventricular mass index (g/m^2)	88 ± 22	81 ± 15	87 ± 14	118 ± 15	128 ± 24	<.0001†
Relative wall thickness	0.41 ± 0.08	0.40 ± 0.07	0.40 ± 0.08	0.44 ± 0.09	0.45 ± 0.10	<.0001†
Normal left ventricular geometry	731 (53%)	675 (64%)	56 (67%)	–	–	<.0001*
Concentric remodeling	411 (30%)	383 (36%)	28 (33%)	–	–	–
Eccentric left ventricular hypertrophy	110 (8%)	–	–	80 (46%)	30 (45%)	–
Concentric left ventricular hypertrophy	130 (9%)	–	–	93 (54%)	37 (55%)	–
Ejection fraction (%)	61 ± 6	61 ± 6	61 ± 5	61 ± 8	60 ± 8	.70†

Data are presented as means and standard deviations (approximately normally distributed variables), medians and IQR (non-normally distributed variables), or frequencies and corresponding percentages (categorical variables).

Abbreviations: LVH: left ventricular hypertrophy; ECG: electrocardiography.

* Pearson’s χ²-test; †One-way ANOVA; §Kruskal–Wallis test.

Table 2. Four multivariable linear regression models listing factors associated with LVMI, RWT, SL and CP.

Risk factor	LVMI	RWT	SL	CP
Age	0.186 (<0.0001)	0.253 (<0.0001)		0.147 (<0.0001)
Male sex	0.228 (<0.0001)		0.065 (0.01)	−0.182 (<0.0001)
Active smoking		0.113 (<0.0001)		−0.080 (0.002)
Antihypertensive medication use Drug class:	0.054 (0.04)	−0.003 (0.92)	0.026 (0.32)	0.054 (0.04)
ACE-I	0.025 (0.32)	0.033 (0.22)	0.015 (0.57)	0.027 (0.29)
Beta blocker	0.065 (0.01)	0.036 (0.18)	0.008 (0.76)	0.048 (0.07)
CCB	0.038 (0.13)	−0.024 (0.37)	0.011 (0.67)	0.038 (0.14)
Diuretic	−0.006 (0.81)	−0.031 (0.23)	−0.039 (0.13)	0.024 (0.35)
Combination	0.049 (0.06)	−0.011 (0.70)	0.065 (0.01)	0.043 (0.10)
BMI	0.104 (<0.0001)	0.068 (0.01)	−0.261 (<0.0001)	0.123 (<0.0001)
Systolic BP	0.166 (<0.0001)		0.185 (<0.0001)
Diastolic BP		0.078 (0.003)		0.132 (<0.0001)
Heart rate	−0.176 (<0.0001)		−0.104 (<0.0001)

Results are reported as standardized β-coefficient (p value).

Abbreviations: LVMI: left ventricular mass index; RWT: relative wall thickness; SL: Sokolow-Lyon voltage combination; CP: Cornell voltage-duration product; ACE-I: angiotensin-converting-enzyme inhibitor; CCB: calcium channel blocker; BMI: body mass index; BP: blood pressure.

Table 3. Two multivariable linear regression models and one binary logistic regression model listing factors influencing the difference between standardized LVMI and SL, standardized LVMI and CP, and discordance between ECG and echocardiography, respectively.

Risk factor	LVMIstandard – SLstandard	LVMIstandard – CPstandard	Discordance
Age (per 10 years for discordance)	0.127 (<0.0001)		1.65 (1.27–2.15) (0.0002)
Male sex	−0.172 (<0.0001)	0.085 (0.002)	0.71 (0.53–0.96) (0.03)
Active smoking		0.120 (<0.0001)
Antihypertensive medication use Drug class:	0.023 (0.37)	0.010 (0.72)	1.41 (1.06–1.87) (0.02)
ACE-I	0.006 (0.81)	0.004 (0.87)	1.19 (0.74–1.90) (0.48)
Beta blocker	0.043 (0.10)	0.018 (0.52)	1.46 (0.94–2.30) (0.10)
CCB	0.025 (0.31)	−0.002 (0.94)	1.85 (0.85–4.04) (0.12)
Diuretic	0.029 (0.25)	−0.031 (0.25)	1.64 (0.71–3.79) (0.25)
Combination	−0.011 (0.67)	0.011 (0.70)	1.31 (0.87–1.97) (0.19)
BMI	0.268 (<0.0001)
Systolic BP (per 10 mmHg for discordance)			1.17 (1.09–1.25) (<0.0001)
Diastolic BP	0.053 (0.04)
Heart rate	−0.075 (0.003)	−0.072 (0.008)
RWT (per 0.10 for discordance)	0.103 (0.0001)		1.21 (1.02–1.43) (0.03)
FPG category Normal fasting glucose (baseline) Impaired fasting glucose Diabetes mellitus		−0.037 (0.22)  −0.076 (0.01)

Results are reported as standardized β-coefficient (p value) for the first two models and odds ratio (95% confidence interval) (p value) for discordance (last column).

Abbreviations: LVMI: left ventricular mass index; SL: Sokolow-Lyon voltage combination; CP: Cornell voltage-duration product; ACE-I: angiotensin-converting-enzyme inhibitor; CCB: calcium channel blocker; BMI: body mass index; BP: blood pressure; RWT: relative wall thickness; FPG: fasting plasma glucose.