Rajiv Agarwal1, Robert P Light. 1. Indiana University and Veterans Administration Medical Center, Indianapolis, IN 46202, USA. ragarwal@iupui.edu
Abstract
BACKGROUND AND OBJECTIVES: The diagnosis of left ventricular hypertrophy (LVH) has prognostic value in the general population. However, among those with chronic kidney disease (CKD), the determinants of electrocardiographic (EKG) LVH and its prognostic value are not clear. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A cross-sectional study was performed among 387 consenting consecutive patients from a veterans hospital with a longitudinal follow-up. RESULTS: The overall prevalence of EKG-LVH by the Sokolow-Lyon criteria was 8% and by the Cornell voltage-duration product was 11%. Compared with non-CKD controls, CKD patients had unadjusted odds ratio (OR) for LVH by Cornell criteria of 2.52 (95% CI 1.18 to 5.42). Significance was lost after adjustment. The unadjusted OR for LVH by Sokolow-Lyon criteria was 2.24 (95% CI 0.95 to 5.33). This OR remained statistically insignificant after multivariate adjustment. Anemia, proteinuria, and 24-hour ambulatory systolic BP were associated with EKG-LVH regardless of diagnostic criteria. After a 7.5-year median follow-up, the hazard ratio for all-cause mortality was not associated with EKG-LVH diagnosed by the Sokolow-Lyon criteria; however, multivariable adjustments made EKG-LVH significant. A statistically significant relationship was seen between mortality and Cornell criteria; however, multivariable adjustments made EKG-LVH nonsignificant. CONCLUSIONS: The Sokolow-Lyon and Cornell EKG-LVH criteria cannot be used interchangeably to diagnose LVH or determine prognosis. Among those with CKD, ambulatory systolic BP predicts all-cause mortality. Moreover, the duration and severity of BP elevation presumably reflected in EKG-LVH diagnosed by Sokolow-Lyon criteria is also of prognostic significance; the Cornell criteria do not carry independent prognostic information.
BACKGROUND AND OBJECTIVES: The diagnosis of left ventricular hypertrophy (LVH) has prognostic value in the general population. However, among those with chronic kidney disease (CKD), the determinants of electrocardiographic (EKG) LVH and its prognostic value are not clear. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A cross-sectional study was performed among 387 consenting consecutive patients from a veterans hospital with a longitudinal follow-up. RESULTS: The overall prevalence of EKG-LVH by the Sokolow-Lyon criteria was 8% and by the Cornell voltage-duration product was 11%. Compared with non-CKD controls, CKDpatients had unadjusted odds ratio (OR) for LVH by Cornell criteria of 2.52 (95% CI 1.18 to 5.42). Significance was lost after adjustment. The unadjusted OR for LVH by Sokolow-Lyon criteria was 2.24 (95% CI 0.95 to 5.33). This OR remained statistically insignificant after multivariate adjustment. Anemia, proteinuria, and 24-hour ambulatory systolic BP were associated with EKG-LVH regardless of diagnostic criteria. After a 7.5-year median follow-up, the hazard ratio for all-cause mortality was not associated with EKG-LVH diagnosed by the Sokolow-Lyon criteria; however, multivariable adjustments made EKG-LVH significant. A statistically significant relationship was seen between mortality and Cornell criteria; however, multivariable adjustments made EKG-LVH nonsignificant. CONCLUSIONS: The Sokolow-Lyon and Cornell EKG-LVH criteria cannot be used interchangeably to diagnose LVH or determine prognosis. Among those with CKD, ambulatory systolic BP predicts all-cause mortality. Moreover, the duration and severity of BP elevation presumably reflected in EKG-LVH diagnosed by Sokolow-Lyon criteria is also of prognostic significance; the Cornell criteria do not carry independent prognostic information.
Authors: Jackson T Wright; George Bakris; Tom Greene; Larry Y Agodoa; Lawrence J Appel; Jeanne Charleston; DeAnna Cheek; Janice G Douglas-Baltimore; Jennifer Gassman; Richard Glassock; Lee Hebert; Kenneth Jamerson; Julia Lewis; Robert A Phillips; Robert D Toto; John P Middleton; Stephen G Rostand Journal: JAMA Date: 2002-11-20 Impact factor: 56.272
Authors: Björn Dahlöf; Richard B Devereux; Sverre E Kjeldsen; Stevo Julius; Gareth Beevers; Ulf de Faire; Frej Fyhrquist; Hans Ibsen; Krister Kristiansson; Ole Lederballe-Pedersen; Lars H Lindholm; Markku S Nieminen; Per Omvik; Suzanne Oparil; Hans Wedel Journal: Lancet Date: 2002-03-23 Impact factor: 79.321
Authors: J Mathew; P Sleight; E Lonn; D Johnstone; J Pogue; Q Yi; J Bosch; B Sussex; J Probstfield; S Yusuf Journal: Circulation Date: 2001-10-02 Impact factor: 29.690
Authors: Mahboob Rahman; Clinton D Brown; Josef Coresh; Barry R Davis; John H Eckfeldt; Nelson Kopyt; Andrew S Levey; Chuke Nwachuku; Sara Pressel; Efrain Reisin; Candace Walworth Journal: Arch Intern Med Date: 2004-05-10
Authors: Vera Krane; Fritz Heinrich; Malte Meesmann; Manfred Olschewski; Jürgen Lilienthal; Christiane Angermann; Stefan Störk; Johann Bauersachs; Christoph Wanner; Stefan Frantz Journal: Clin J Am Soc Nephrol Date: 2009-01-21 Impact factor: 8.237
Authors: Sofia Skampardoni; Dimitrios Poulikakos; Marek Malik; Darren Green; Philip A Kalra Journal: Nephrol Dial Transplant Date: 2019-07-01 Impact factor: 5.992
Authors: Seung Jun Kim; Hyung Jung Oh; Dong Eun Yoo; Dong Ho Shin; Mi Jung Lee; Hyoung Rae Kim; Jung Tak Park; Seung Hyeok Han; Tae-Hyun Yoo; Kyu Hun Choi; Shin-Wook Kang Journal: PLoS One Date: 2012-04-17 Impact factor: 3.240
Authors: Matthias C Braunisch; Peter Gundel; Stanislas Werfel; Christopher C Mayer; Axel Bauer; Bernhard Haller; Roman Günthner; Georg Lorenz; Susanne Angermann; Julia Matschkal; Carolin Schaller; Christopher Holzmann-Littig; Stephan Kemmner; Johannes Mann; Axel Krieter; Lutz Renders; Siegfried Wassertheurer; Georg Schmidt; Uwe Heemann; Marek Malik; Christoph Schmaderer Journal: J Nephrol Date: 2021-05-20 Impact factor: 3.902