OBJECTIVES: This study was conducted to test the hypothesis that the time-voltage integral of the QRS complex can improve the electrocardiographic (ECG) identification of left ventricular hypertrophy. BACKGROUND: Standard ECG criteria have exhibited poor sensitivity for left ventricular hypertrophy at acceptable levels of specificity. However, left ventricular mass may be more closely related to the time-voltage integral of the summed left ventricular dipole than to QRS duration or voltages used in standard ECG criteria. METHODS: Standard 12-lead ECGs, orthogonal lead signal-averaged ECGs and echocardiograms were obtained in 62 male control subjects without left ventricular hypertrophy and 51 men with left ventricular hypertrophy defined by echocardiographic criteria (indexed left ventricular mass > 125 g/m2). Voltage of the QRS complex was integrated over the total QRS duration in leads X, Y and Z to calculate the time-voltage integral of each orthogonal lead, of the maximal spatial vector complex and of the horizontal, frontal and sagittal plane vector complexes. RESULTS: At matched specificity of 99%, the 73% (37 of 51) sensitivity of the time-voltage integral of the vector QRS complex in the horizontal plane was significantly greater than the 10% sensitivity of the Romhilt-Estes point score, the 16% sensitivity of QRS duration alone, the 22% sensitivity of Cornell voltage, the 33% sensitivity of the 12-lead sum of QRS voltage and the 37% sensitivity of Sokolow-Lyon voltage (each p < 0.001). Sensitivity of the horizontal plane time-voltage integral was also greater than the 10% to 51% sensitivity of the time-voltage integral calculated in the individual X, Y or Z leads (p < 0.01 to < 0.001), the 18% and 35% sensitivity of the time-voltage integrals of the frontal and sagittal plane vectors (p < 0.001) and the 49% sensitivity of the time-voltage integral of the maximal spatial vector complex calculated from all three orthogonal leads (p < 0.001). Comparison of receiver operating characteristic curves confirmed that the superior performance of the horizontal plane time-voltage integral relative to standard and other signal-averaged criteria was independent of partition value selection. CONCLUSIONS: These findings suggest that use of the time-voltage integral of the QRS complex, a method that can be readily implemented on commercially available computerized ECG systems, can improve the accuracy of ECG methods for the identification of left ventricular hypertrophy.
OBJECTIVES: This study was conducted to test the hypothesis that the time-voltage integral of the QRS complex can improve the electrocardiographic (ECG) identification of left ventricular hypertrophy. BACKGROUND: Standard ECG criteria have exhibited poor sensitivity for left ventricular hypertrophy at acceptable levels of specificity. However, left ventricular mass may be more closely related to the time-voltage integral of the summed left ventricular dipole than to QRS duration or voltages used in standard ECG criteria. METHODS: Standard 12-lead ECGs, orthogonal lead signal-averaged ECGs and echocardiograms were obtained in 62 male control subjects without left ventricular hypertrophy and 51 men with left ventricular hypertrophy defined by echocardiographic criteria (indexed left ventricular mass > 125 g/m2). Voltage of the QRS complex was integrated over the total QRS duration in leads X, Y and Z to calculate the time-voltage integral of each orthogonal lead, of the maximal spatial vector complex and of the horizontal, frontal and sagittal plane vector complexes. RESULTS: At matched specificity of 99%, the 73% (37 of 51) sensitivity of the time-voltage integral of the vector QRS complex in the horizontal plane was significantly greater than the 10% sensitivity of the Romhilt-Estes point score, the 16% sensitivity of QRS duration alone, the 22% sensitivity of Cornell voltage, the 33% sensitivity of the 12-lead sum of QRS voltage and the 37% sensitivity of Sokolow-Lyon voltage (each p < 0.001). Sensitivity of the horizontal plane time-voltage integral was also greater than the 10% to 51% sensitivity of the time-voltage integral calculated in the individual X, Y or Z leads (p < 0.01 to < 0.001), the 18% and 35% sensitivity of the time-voltage integrals of the frontal and sagittal plane vectors (p < 0.001) and the 49% sensitivity of the time-voltage integral of the maximal spatial vector complex calculated from all three orthogonal leads (p < 0.001). Comparison of receiver operating characteristic curves confirmed that the superior performance of the horizontal plane time-voltage integral relative to standard and other signal-averaged criteria was independent of partition value selection. CONCLUSIONS: These findings suggest that use of the time-voltage integral of the QRS complex, a method that can be readily implemented on commercially available computerized ECG systems, can improve the accuracy of ECG methods for the identification of left ventricular hypertrophy.
Authors: Jonathan Chrispin; Aditya Jain; Elsayed Z Soliman; Eliseo Guallar; Alvaro Alonso; Susan R Heckbert; David A Bluemke; João A C Lima; Saman Nazarian Journal: J Am Coll Cardiol Date: 2014-03-19 Impact factor: 24.094
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Authors: Larisa G Tereshchenko; Alan Cheng; Barry J Fetics; Barbara Butcher; Joseph E Marine; David D Spragg; Sunil Sinha; Darshan Dalal; Hugh Calkins; Gordon F Tomaselli; Ronald D Berger Journal: J Electrocardiol Date: 2010-11-20 Impact factor: 1.438
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Authors: Larisa G Tereshchenko; Charles A Henrikson; Nona Sotoodehnia; Dan E Arking; Sunil K Agarwal; David S Siscovick; Wendy S Post; Scott D Solomon; Josef Coresh; Mark E Josephson; Elsayed Z Soliman Journal: J Am Heart Assoc Date: 2014-11-21 Impact factor: 5.501
Authors: Sandra Costa Fuchs; Carlos E Poli-de-Figueiredo; José A Figueiredo Neto; Luiz César N Scala; Paul K Whelton; Francisca Mosele; Renato Bandeira de Mello; José F Vilela-Martin; Leila B Moreira; Hilton Chaves; Marco Mota Gomes; Marcos R de Sousa; Ricardo Pereira E Silva; Iran Castro; Evandro José Cesarino; Paulo Cesar Jardim; João Guilherme Alves; André Avelino Steffens; Andréa Araujo Brandão; Fernanda M Consolim-Colombo; Paulo Ricardo de Alencastro; Abrahão Afiune Neto; Antônio C Nóbrega; Roberto Silva Franco; Dario C Sobral Filho; Alexandro Bordignon; Fernando Nobre; Rosane Schlatter; Miguel Gus; Felipe C Fuchs; Otávio Berwanger; Flávio D Fuchs Journal: J Am Heart Assoc Date: 2016-12-13 Impact factor: 5.501