(Hypertension. 2000;36:54.)
© 2000 American Heart Association, Inc.
Scientific Contributions |
Performance of Classic Electrocardiographic Criteria for Left Ventricular Hypertrophy in an African Population
From the Division of Cardiology (C.J., F.Perret, N.Z., L.K.), Department of Internal Medicine, University Hospital, Lausanne, Switzerland; Group for Cardiovascular and Epidemiological Transition (F.Perret., P.B., G. van M., F.Paccaud), Institute for Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland; and Unit of Prevention and Control of Cardiovascular Disease (P.B., G.M.), Ministry of Health, Seychelles.
Correspondence to Dr François Perret, Division de Cardiologie, BH 10, University of Lausanne, 1011 Lausanne, Switzerland. E-mail fperret{at}hospvd.ch
Abstract—ECG criteria for left
ventricular hypertrophy (LVH) have been almost
exclusively elaborated and calibrated in white populations. Because
several interethnic differences in ECG characteristics have been found,
the applicability of these criteria to African individuals remains to
be demonstrated. We therefore investigated the performance of
classic ECG criteria for LVH detection in an African population.
Digitized 12-lead ECG tracings were obtained from 334 African
individuals randomly selected from the general population of the
Republic of Seychelles (Indian Ocean). Left ventricular
mass was calculated with M-mode echocardiography
and indexed to body height. LVH was defined by taking the 95th
percentile of body height–indexed LVM values in a reference subgroup.
In the entire study sample, 16 men and 15 women (prevalence 9.3%) were
finally declared to have LVH, of whom 9 were of the reference
subgroup. Sensitivity, specificity, accuracy, and positive and negative
predictive values for LVH were calculated for 9 classic ECG criteria,
and receiver operating characteristic curves were computed. We also
generated a new composite time-voltage criterion with stepwise multiple
linear regression: weighted time-voltage
criterion=(0.2366RaVL+0.0551RV5+0.0785SV3+
0.2993TV1)xQRS duration. The Sokolow-Lyon criterion
reached the highest sensitivity (61%) and the RaVL voltage
criterion reached the highest specificity (97%) when evaluated at
their traditional partition value. However, at a fixed specificity of
95%, the sensitivity of these 10 criteria ranged from 16% to 32%.
Best accuracy was obtained with the RaVL voltage criterion
and the new composite time-voltage criterion (89% for both). Positive
and negative predictive values varied considerably depending on the
concomitant presence of 3 clinical risk factors for LVH (hypertension,
age 
50 years, overweight). Median positive and negative predictive
values of the 10 ECG criteria were 15% and 95%, respectively, for
subjects with none or 1 of these risk factors compared with 63% and
76% for subjects with all of them. In conclusion, the
performance of classic ECG criteria for LVH detection was
largely disparate and appeared to be lower in this population of East
African origin than in white subjects. A newly generated composite
time-voltage criterion might provide improved performance. The
predictive value of ECG criteria for LVH was considerably enhanced with
the integration of information on concomitant clinical risk factors
for LVH.
Key Words: left ventricle • hypertrophy • ethnic groups • electrocardiography • echocardiography