Abstract 2484: ECG Screening Criteria for LVH Does Not Correlate With Diagnosis of Hypertrophic Cardiomyopathy
Introduction. The ECG criteria of “LVH by voltage only” (LVHV) accounts for up to 18% of abnormalities found in large scale pre-participation screening exams. However, this ECG finding is an insensitive marker for LVH, seen in up to 40% of highly trained athletes and in only 2% of those with hypertrophic cardiomyopathy (HCM). If LVHV could be re-classified as “not likely to be associated with disease,” the number of false positive findings during ECG screening exams could be reduced. We sought to determine if LVHV was associated with the diagnosis of HCM in a population of young adults undergoing pre-participation screening ECGs.
Methods. The study included 8,395 high school students undergoing ECG screening exams from 5/08–5/09. Subjects with the abnormal ECG finding of LVHV underwent further testing with limited echocardiograms. LVHV was diagnosed using either modified Corrado (rV5 or rV6 >30mm, r in II >20mm), Sokolow-Lyon (sV1 + rV5 or rV6 >35mm) or Davignon (rV5 or rV6 >95%-ile for age) criteria. HCM was defined as LV septum or posterior wall thickness greater than 13 mm. Findings of asymmetric hypertrophy or systolic anterior motion of the mitral valve (SAM) were also noted. LV mass (grams) was determined by the Devereux equation. LV mass index (LV mass/height 2.7) was calculated for all subjects.
Results. One hundred (86 male, 14 female) consecutive subjects with LVHV underwent further testing. Ages ranged from 14 to 18 yrs (mean 15.5 yrs). All subjects met modified Corrado criteria for LVHV while 83% met either Sokolow-Lyon or Davignon criteria. None of the subjects were found to have the diagnosis of HCM, SAM or asymmetric hypertrophy. None of the subjects were found to have elevated LV mass index (greater than 95%-ile for age). Other diagnoses found by echocardiogram included bicuspid aortic valve (1), and mitral valve regurgitation (1).
Conclusions. The ECG criteria of LVHV was not associated with diagnosis of HCM or increased LV mass in young adults undergoing pre-participation screening ECGs. Re-classification of LVHV as “not likely to be associated with disease” may help to reduce the number of false positive findings during ECG screening exams.