gms | German Medical Science

Question: The aim of the study was to examine the relationship between electrocardiographic QRS voltage and duration criteria for diagnosis of left ventricular hypertrophy (LVH) and echocardiographic LV geometry pattern in pts with essential hypertension.

Method used: Standard 12-lead ecg, echocardiography and ABPM were performed in consecutive 101 pts with essential hypertension, without signs of CAD, mean age 62 +/- 4,5 yrs, 61 men and 40 women.Subjects were divided into 4 groups of echocardiographic LVH and geometry pattern based on LVMI (left ventricular mass index; LVMI >125 g/m2 as a cut-off value for diagnosis of LVH) and RWT (relative wall thickness): normal geometry (N, n=42), concentric remodeling (CR, n=17), concentric hypertrophy (CH, n=15) and eccentric hypertrophy (EH, n=23).The following electrocardiographic QRS voltage and duration criteria for LVH were evaluated: QRS voltage criteria- Cornell voltage (CV), sum of 12-lead QRS voltage (S) and QRS duration criteria - QRS duration (D), QRS duration x sum of 12-lead QRS voltage (S x D), Cornell Product (CP).Then the relations between LVH ecg parameters and echocardiographic parameters like left ventricular mass (LVM) and its index (LVMI), relative wall thickness (RWT) were analyzed in linear regression analysis.Multiple logistic regression analysis was perfomed to check if above relationship is independent on age, sex, BMI and ABPM parameters.

Results: Median values of QRS time dependent parameter- D did not differ between pts with 4 patterns of LVH and geometry. Median values of ORS voltage criteria: S (1,7 m V), CV (2,2 m V), and QRS duration and voltage product criteria: S x D (147,2 m Vms) and CP 200,0 m Vms) were the highest in pts with CH and differ significantly between pts with N and CR but not with EH.Regression analysis revealed significant correlations between LVM, LVMI and S (r=0,4; r=0,45 repectively, p=0,0000 for all) and S x D (r=0,4; r=0,44) and CV (r=0,39; r=0,39) and CP (r=0,39; r=0,39).These relations remained independent after adjustment to age, sex, BMI and ABPM parameters in multiple logistic regression analysis.No correlations of RWT and any of above ecg LVH parameters were found.

Conclusions: Both QRS voltage and duration LVH ecg criteria were correlated with LVM and its index but not with RWT.However the highest median values of QRS voltage and duration product criteria were observed in patients with CH, none of them can differentiate pattern of LVH and geometry.