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,☆☆,,★★,,♢♢,

https://doi.org/10.1054/jelc.2000.7667Get rights and content

Abstract

The validity of the reported high prevalence of left ventricular hypertrophy (LVH) among African-American men and women has been questioned owing to conflicting echocardiographic evidence. We used echocardiographic left ventricular mass (LVM) from M-mode measurements to evaluate associations between LVM, body size, and electrocardiographic (ECG) variables in 3,627 white and African-American men and women 65 years of age and older who were participants of the Cardiovascular Health Study (CHS), a multicenter cohort study of risk factors for coronary heart disease and stroke. ECG amplitudes used in LVH criteria were substantially higher in African-Americans, with apparent LVH prevalence 2 to 3 times higher in African American men and women than in white men and women, although there was no significant racial difference in echocardiographic LVM. The higher apparent LVH prevalence by Sokolow-Lyon criteria in African-American men is in part owing to smaller lateral chest diameter. In women, reasons for racial differences in ECG LVH prevalence remain largely unexplained although a small part of the excess LVH in African-American women by the Sokolow-Lyon criteria appears to be owing to a larger lateral chest semidiameter in white women. ECG variables alone were too inaccurate for LVM prediction, and it was necessary to incorporate in all ECG models body weight that was properly adjusted for race and sex. This resulted in modest LVM prediction accuracy, with R-square values ranging from.22 to.36. Race- and sex-specific ECG models introduced for LVM estimation with an appropriate adjustment for body size differences are expected to facilitate evaluation of LVH status in contrasting racial population groups.

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      Sokolow Lyon criteria have mainly been developed on white populations and reasons why these criteria are more likely to result into false positive LVH diagnosis in African origin populations have been attributed to socioeconomic and nutritional factors, differences in body shape, fat distributions, and physiological differences in ventricle sizes [30,31]. Higher QRS amplitudes in older populations of African-Americans as compared to white populations have been described for both men and women despite comparable left ventricular mass as measured by echocardiography, indicating racial differences which were partly explained by smaller lateral chest diameter in individuals of African origin [32]. As reviewed by Fraley et al. [33], higher BMI or obesity is known to lead to lower QRS voltages effecting especially ECG LVH criteria that rely on left or right precordial voltage such as the Sokolow Lyon Index.

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    Division of Cardiology, Georgetown University Medical Center, Washington, DC,

    ☆☆

    the CHS Coordinating Center, University of Washington, Seattle, WA,

    §the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD,

    ★★

    Division of Cardiology, Albany Medical College, Albany, NY,

    The John Hopkins University, Baltimore, MD.

    ♢♢

    Supported by contracts N01-HC-85079 through N01-HC-8586 from the National Heart, Lung, and Blood Institute, and Georgetown Echo RC-HL 35129. A list of the participating institutions and principal staff is in the Appendix.

    Reprint requests: Pentti M. Rautaharju, MD, PhD, EPICARE Center, Suite 505, Piedmont Plaza Two, 2000 West First Street, Winston-Salem, NC 27104.

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