Abstract 4900: Left Ventricular Hypertrophy by Electrocardiography in the African-American Study of Kidney Disease and Hypertension
Purpose: Electrocardiogram (ECG) criteria for left ventricular hypertrophy (LVH) have low sensitivity in the general population though a high rate of ECG LVH has been consistently reported in African-Americans (AA). The purpose of the current study was to evaluate the value of ECG criteria among AA with hypertensive kidney disease, a population with a high burden of LVH.
Methods: AA with hypertensive kidney disease (n = 645) were evaluated for LVH on echocardiography and ECG as part of the African-American Study of Kidney Disease and Hypertension (AASK) cohort. ECGs were read by two cardiologists at an independent core laboratory using the two Sokolow-Lyon criteria and the Cornell criteria. LVH on echocardiography was defined as left ventricular mass index >49.2 and >46.7 g/m2.7 in men and women respectively, and was used as the gold standard.
Results: The mean age of the patients was 60.1 years (SD = 10.1), 39.2% were women and 12.9% had diabetes. All patients had hypertensive kidney disease with a mean serum creatinine of 2.30 mg/dL (SD = 1.39). Sixty-nine percent of the population had LVH on echocardiogram, while 35% had LVH by any of the ECG criteria; 15% had LVH by Sokolow-Lyon-1 (S in V1 + R in V5 or V6 whichever is larger > 35 mm or R in V5 or V6 >25mm), 16% by Sokolow-Lyon-2 (R in aVL > = 11 mm) and 20% by Cornell criteria (S in V3 + R in aVL >28 mm in men, and S in V3 + R in aVL > 20 mm in women). LVH by ECG in AA had low sensitivity by any of the criteria, while specificity was higher (Table⇓). The NPV were low and PPV were higher regardless of the ECG criteria applied, and the kappa statistic indicated poor agreement between ECG- and echocardiogram-defined LVH.
Conclusions: LVH by ECG had low sensitivity in this cohort of AA with hypertensive kidney disease. These results are consistent with previous findings from Caucasian and AA populations without chronic kidney disease.