Reliability of electrocardiographic surrogates of left ventricular mass in patients with chronic kidney disease

Objective: Left ventricular hypertrophy (LVH) is a prevalentcondition in chronic kidney disease (CKD) very oftenunderdiagnosed and misdiagnosed. Electrocardiography(ECG) is an easily accessible LVH diagnostic tool. Weevaluated the usefulness of commonly applied ECG criteriafor LVH diagnosis in CKD patients.Methods: Cross-sectional evaluation of 253 nondialysisdependentCKD stages 3–5 patients (61 [53–67] years;65% men). Left ventricular mass (LVM) was assessed byechocardiography (ECHO). ECG was performed to assessCornell voltage and Sokolow–Lyon voltage and theirproducts (Cornell product and Sokolow–Lyon product,respectively).Results: The prevalence of LVH ranged from 72 to 89%depending on ECHO criteria used. Cornell product showedthe best correlation with ECHO-estimated LVM (r»0.41;P<0.001). Across sex-specific tertiles of ECHO-LVM, ECGcriteria increased and patients were more oftenhypertensive, obese, fluid overloaded, inflamed, and withhigher albuminuria. Cornell product showed the strongestassociation with ECHO-LVM in crude and adjustedregression models, and the higher predictive performancefor all the ECHO-based LVH definitions. However, whenapplying literature-based ECG cut-offs for LVH diagnosis,Sokolow–Lyon product showed a higher specificity. Theagreement between ECG criteria cut-offs and ECHO-baseddefinitions of LVH was in general poor, and the number ofpatients reclassified correctly by ECHO ranged from 77 to94%.Conclusion: Our data suggest that ECG alone is a weakindicator of LVH, and do not support its routine use as aunique tool in the screening of LVH in CKD patients.Further studies are needed to confirm these results and totry establishing adequate cut-offs for LVH diagnosis in thispopulation.