From the Division of Cardiology, Department of Medicine, The New York
Hospital-Cornell Medical Center, New York, NY.
Correspondence to Peter M. Okin, MD, The New York Hospital-Cornell Medical Center, 525 East 68th St, New York, NY 10021. E-mail pokin{at}mail.med.cornell.edu
Abstract—Identification of left
ventricular hypertrophy (LVH) using 12-lead ECG
criteria based primarily on QRS amplitudes has been limited by poor
sensitivity at acceptable levels of specificity. Because the
product of QRS voltage and duration, as an approximation of the
time-voltage area of the QRS complex, can improve accuracy of the
12-lead ECG for LVH, we examined the diagnostic value of
true time-voltage area measurements of QRS complexes from the standard
12-lead ECG. Standard 12-lead ECGs and echocardiograms were obtained in
175 control subjects without LVH and in 74 patients with regurgitant
valvular heart disease and LVH defined by
echocardiographic criteria (indexed LV mass >110
g/m2 in women and >125 g/m2 in men). Standard
voltage criteria, voltage-duration products (voltage multiplied by
QRS duration), and true time-voltage areas of the QRS were calculated
for Sokolow-Lyon criteria (SV1+RV5/6) and the
12-lead sum of voltage criteria. Test sensitivities were compared using
gender-specific partitions with matched specificity of 98% in the 175
subjects without LVH. Measurement of the time-voltage area
significantly improved sensitivity for both criteria. The 76%
sensitivity of the 12-lead sum area and 65% sensitivity of
Sokolow-Lyon area were significantly greater than the 54% sensitivity
of the approximation of QRS area provided by each voltage-duration
product (P<.001 and P=.021) and than
the 46% and 43% sensitivities of the respective simple voltage
criteria (each P<.001). Comparison of receiver
operating characteristic curves confirmed the superior overall
performance of time-voltage area criteria compared with both
voltage-duration products and simple voltage criteria. These
results suggest that use of time-voltage areas can dramatically improve
identification of LVH by 12-lead ECG. Further study of this approach is
needed to identify optimal criteria for LVH based on the time-voltage
area measurements from the 12-lead ECG.
© 1998 American Heart Association, Inc.
Scientific Contributions
Time-Voltage QRS Area of the 12-Lead Electrocardiogram
Detection of Left Ventricular Hypertrophy
Key Words: echocardiography • electrocardiography • hypertrophy
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