2016


To access this material please log in or register

Register Authorize
2016/№5

Determination of the left ventricular myocardial mass by signal-averaged electrocardiography

Semenkin A.A.1, Chindareva O.I.1, Makhrova N.V.1, Nechaeva G.I.1, Potapov V.V.2, Zhivilova L.A.1, Sivkov I.E.3, Semenova E.V.1
1 – State Budgetary Educational Institution of Higher Professional Education, “Omsk State Medical University” of the RF Ministry of Health Care, Lenina 12, Omsk 644043
2 – Budgetary Institution of Health Care of the Omsk Region, “Clinical Diagnostic Center”, Iljinskaya 9, Omsk 644024
3 – Limited Liability Company, Informational Systems of Services Art”, Prospekt Marksa, 18/28, Omsk 644042

Keywords: signal-averaged electrocardiography, left ventricular myocardial mass

DOI: 10.18087/rhfj.2016.5.2255

Background. Along with EchoCG, ECG has been traditionally used for detection of LV hypertrophy (LVH). Proposed models for estimation of LV myocardial mass (LVMM) using the ECG method have several disadvantages. Aim. To evaluate a possibility of determining LVMM using parameters of signal-averaged ECG. Materials and methods. 185 volunteers (108 patients with uncomplicated AH and 77 subjects with normal BP aged 35 to 65) were evaluated using EchoCG and 12-lead ECG with subsequent averaging of the electrocardiosignal by original software. 168 sex- and age-matched individuals (120 patients with uncomplicated AH and 48 subjects with normal BP) were evaluated using EchoCG and traditional (non-signal averaged) ECG. To evaluate the reproducibility of LVMM determined by parameters of signal-averaged and non-signal averaged ECG 17 volunteers without apparent disease aged 18–25 were examined at a week interval. Results. The correlation analysis showed positive LVMM correlations with gender, age, body weight index (BWI), body surface area (BSA), and more than 66 parameters of signal-averaged ECG. Significant independent LVMM predictors included age (p<0.01), gender (p<0.001), BWI (p<0.001), maximum duration of the Pd wave (p<0.01), sum of the R wave in AVL lead and the S wave in V3 lead (RAVL+SV3) (p<0.001), and difference between T wave amplitudes in V1 and V6 leads (TV1–TV6) (p<0.01). The proposed model explained 67% of LVMM variability (R=0.82; p<0.001). When parameters of non-signal averaged ECG were used the obtained model also demonstrated a significant although less pronounced correlation with EchoCG LVMM (R=0.71, R2=0.50; p<0.001). In assessing the reproducibility of LVMM calculated by data of signal-averaged ECG, the variability was almost half of that calculated from data of non-signal averaged ECG (4.6% vs. 7.9%; р<0.05). Conclusion. Using signal-averaged ECG provides more robust LVMM measurements compared to traditional ECG due to higher reproducibility of the method.
  1. Haider AW, Larson MG, Benjamin EJ, Levy D. Increased left ventricular mass and hypertrophy are associated with increased risk for sudden death. J Am Coll Cardiol. 1998 Nov;32 (5):1454–9.
  2. Kannel WB, Gordon T, Offutt D. Left ventricular hypertrophy by electrocardiogram: prevalence, incidence and mortality in the Framingham study. Ann Intern Med. 1969 Jul;71 (1):89–105.
  3. Vakili BA, Okin PM, Devereux RB. Prognostic implications of left ventricular hypertrophy. Am Heart J. 2001 Mar;141 (3):334–41.
  4. Mathew J, Sleight P, Lonn E, Johnstone D, Pogue J, Yi Q et al. Reduction of cardiovascular risk by regression of electrocardiographic markers of left ventricular hypertrophy by the angiotensin-converting enzyme inhibitor ramipril. Circulation. 2001 Oct 2;104 (14):1615–21.
  5. Okin PM, Devereux RB, Jern S, Kjeldsen SE, Julius S, Nieminen MS et al. Regression of electrocardiographic left ventricular hypertrophy during antihypertensive treatment and the prediction of major cardiovascular events. JAMA. 2004 Nov 17;292 (19):2343–9.
  6. Devereux RB, Wachtell K, Gerdts E, Boman K, Nieminen MS, Papademetriou V et al. Prognostic significance of left ventricular mass change during treatment of hypertension. JAMA. 2004 Nov 17;292 (19):2350–6.
  7. Pierdomenico SD, Lapenna D, Cuccurullo F. Regression of echocardiographic left ventricular hypertrophy after 2 years of therapy reduces cardiovascular risk in patients with essential hypertension. Am J Hypertens. 2008 Apr;21 (4):464–70.
  8. Devereux RB. Is the ECG still useful for detection of the left ventricular hypertrophy? Circulation. 1990 Mar;81 (3):1144–6.
  9. Devereux RB, Koren MJ, de Simone G, Okin PM, Kligfield P. Methods for detection of left ventricular hypertrophy: application to hypertensive heart disease. Eur Heart J. 1993 Jul;14 (Suppl D): 8–15.
  10. Sokolow M, Lyon TP. The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J. 1949 Feb;37 (2):161–86.
  11. Casale PN, Devereux RB, Kligfield P, Eisenberg RR , Miller DH, Chaudhary BS, Phillips MC. Electrocardiographic detection of left ventricular hypertrophy: development and prospective validation of improved criteria. J Am Coll Cardiol. 1985 Sep;6 (3):572–80.
  12. Molloy TJ, Okin PM, Devereux RB, Kligfield P. Electrocardiographic detection of left ventricular hypertrophy by the simple QRS voltage-duration product. J Am Coll Cardiol. 1992 Nov 1;20 (5):1180–6.
  13. Scott RC, Seiwert VJ, Simon DL, McGuire J. Left ventricular hypertrophy: a study of the accuracy of current electrocardiographic criteria when compared with autopsy findings in one hundred cases. Circulation. 1955 Jan;11 (1):89–96.
  14. Pewsner D, Jüni P, Egger M, Battaglia M, Sundstrom J, Bachmann LM. Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review. BMJ. 2007 Oct 6;335 (7622):711.
  15. Jain A, Tandri H, Dalal D, Chahal H, Soliman EZ, Prineas RJ et al. Diagnostic and prognostic utility of ECG for left ventricular hypertrophy defined by MRI in relationship to ethnicity: the Multi-Ethnic Study of Atherosclerosis (MESA). Am Heart J. 2010 Apr;159 (4):652–8.
  16. Verdecchia P, Dovellini EV, Gorini M, Gozzelino G, Lucci D, Milletich A, Maggioni AP. Comparison of electrocardiographic criteria for diagnosis of left ventricular hypertrophy in hypertension: the MAVI study. Ital Heart J. 2000 Mar;1 (3):207–15.
  17. Devereux RB, Casale PN, Eisenberg RR , Miller DH, Kligfield P. Electrocardiographic detection of left ventricular hypertrophy using echocardiographic determination of left ventricular mass as the reference standard. Comparison of standard criteria, computer diagnosis and physician interpretation. J Am Coll Cardiol. 1984 Jan;3 (1):82–7.
  18. Wolf HK, Burggraf GW, Cuddy E, Milliken JA, Rautaharju PM, Smith ER , Warren JW. Prediction of left ventricular mass from the electrocardiogram. J Electrocardiol. 1991 Apr;24 (2):121–7.
  19. de Vries SO, Heesen WF, Beltman FW, Kroese AH, May JF, Smit AJ, Lie KI. Prediction of the left ventricular mass from the electrocardiogram in systemic hypertension. Am J Cardiol. 1996 May 1;77 (11);974–8.
  20. Rautaharju PM, Park LP, Gottdiener JS, Siscovick D, Boineau R, Smith V, Powe NR . Race- and sex-specific ECG models for left ventricular mass in older populations. Factors influencing overestimation of left ventricular hypertrophy prevalence by ECG criteria in African-Americans. J Electrocardiol. 2000 Jul;33 (3):205–18.
  21. Mosteller RD. Simplified calculation of body-surface area. N Engl J Med. 1987 Oct 22;317 (17):1098.
  22. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015 Jan;28 (1):1–39.e14.
  23. Crow RS, Prineas RJ, Rautaharju P, Hannan P, Liebson PR. Relation between electrocardiography and echocardiography for left ventricular mass in mild systemic hypertension (results from treatment of mild systemic hypertension study). Am J Cardiol. 1995 Jun 15;75 (17):1233–8.
  24. Casale PN, Devereux RB, Alonso DR , Campo E, Kligfield P. Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings. Circulation. 1987 Mar;75 (3):565–72.
  25. Devereux RB, Alonso DR , Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986 Feb 15;57 (6):450–8.
  26. Bachenberg TC, Shub C, Hauck AJ, Edwards WD. Can anatomical left ventricular mass be estimated reliably by M-mode echocardiography? A clinicopathological study of ninety-three patients. Echocardiography. 1991 Jan;8 (1):9–15.
Semenkin A.A., Chindareva O.I., Makhrova N.V., Nechaeva G.I., Potapov V.V., Zhivilova L.A. et al. Determination of the left ventricular myocardial mass by signal-averaged electrocardiography. Russian Heart Failure Journal. 2016;17 (5):333–338

To access this material please log in or register

Register Authorize
Ru En