Abstract 1924: Evaluation of ECG Criteria for Left Ventricular Hypertrophy in Aortic Valve Disease using Cardiac Magnetic Resonance Imaging
The purpose of our study was to evaluate seven different electrocardiographic criteria for of left ventricular hypertrophy (LVH) as determined by cardiac magnetic resonance imaging (CMRI). Additionally, the effects of concentric and eccentric LVH on depolarization and repolarization were assessed. A total of 220 subjects were studied. 100 healthy volunteers without cardiac history or medication were compared to 120 patients with a high prevalence of LVH due to aortic valve disease. As ECG criteria for LVH, we assessed the Sokolow-Lyon voltage, Sokolow-Lyon product, Gubner-Ungerleider voltage, Cornell voltage, Cornell product, Perugia score and Romhilt-Estes score. Patients with aortic valve disease presented with significantly higher LV mass (199 ± 72 g vs. CTRL 98 ± 27 g, p < 0.001) and volume (168 ± 74 ml vs. CTRL 131 ± 33 ml, p < 0.001) as compared to control. The prevalence of MRI-LVH was 86% based upon the 95th percentile of CTRL. The prevalence of ECG-LVH ranged from 33% to 80% according to the applied ECG criteria. All ECG criteria demonstrated a significant correlation with LV mass and chamber size. The highest predictive values were achieved by the Romhilt-Estes score 4 points with a sensitivity and specificity of 86% and 81%, respectively (PPV = 91%, NPV = 74%). There was no difference in all ECG criteria between concentric and eccentric LVH. However, amplitudes (mV) of ST-segment (Mean ± SEM lead V5 −0.06 ± 0.01 vs. −0.02 ± 0.01, p < 0.05) and T-wave (lead V5 −0.03 ± 0.04 vs. 0.18 ± 0.05, p < 0.05) in the anterolateral leads (V5 ,V6 , I, all p < 0.05) were deeper in concentric LVH than in eccentric LVH while no differences were noted with respect to depolarization. By calibration with CMRI, a wide range of predictive values was found for the various ECG criteria for LVH with the most favourable results for the Romhilt-Estes score. As electrocardiographic correlate for concentric LVH as compared with eccentric LVH, a significant ST-segment and T-wave depression in the anterolateral leads was noted.