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

OBJECTIVE: Left ventricular hypertrophy (LVH) is a prevalent condition in chronic kidney disease (CKD) very often underdiagnosed and misdiagnosed. Electrocardiography (ECG) is an easily accessible LVH diagnostic tool. We evaluated the usefulness of commonly applied ECG criteria for LVH diagnosis in CKD patients. METHODS: Cross-sectional evaluation of 253 nondialysis-dependent CKD stages 3-5 patients (61 [53-67] years; 65% men). Left ventricular mass (LVM) was assessed by echocardiography (ECHO). ECG was performed to assess Cornell voltage and Sokolow-Lyon voltage and their products (Cornell product and Sokolow-Lyon product, respectively). RESULTS: The prevalence of LVH ranged from 72 to 89% depending on ECHO criteria used. Cornell product showed the best correlation with ECHO-estimated LVM (ρ = 0.41; P <0.001). Across sex-specific tertiles of ECHO-LVM, ECG criteria increased and patients were more often hypertensive, obese, fluid overloaded, inflamed, and with higher albuminuria. Cornell product showed the strongest association with ECHO-LVM in crude and adjusted regression models, and the higher predictive performance for all the ECHO-based LVH definitions. However, when applying literature-based ECG cut-offs for LVH diagnosis, Sokolow-Lyon product showed a higher specificity. The agreement between ECG criteria cut-offs and ECHO-based definitions of LVH was in general poor, and the number of patients reclassified correctly by ECHO ranged from 77 to 94%. CONCLUSION: Our data suggest that ECG alone is a weak indicator of LVH, and do not support its routine use as a unique tool in the screening of LVH in CKD patients. Further studies are needed to confirm these results and to try establishing adequate cut-offs for LVH diagnosis in this population.

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.