The use of echocardiography compared to electrocardiogram when screening for left ventricular hypertrophy in hypertensive patients: A cross-sectional study.
Marijn Marc BultThomas Flint van de ReeAnna Maria WindKai Morris HurleyMarcel Allard van de ReePublished in: Journal of clinical hypertension (Greenwich, Conn.) (2024)
Left ventricular hypertrophy (LVH) is often used as an indicator to assess hypertension-mediated organ damage (HMOD), alongside hypertensive retinopathy (HR) and nephropathy. Assessment of HMOD is crucial when making decisions about treatment optimization. Despite longstanding debate over its reliability to detect LVH, it is common practice to perform an electrocardiogram (ECG) instead of directly assessing left ventricular mass with echocardiography. In this study, the presence of LVH was evaluated using both ECG and echocardiography among consecutive patients suspected of therapy-resistant hypertension or secondary hypertension in the outpatient clinic of the Department of Internal Medicine at the Diakonessen Hospital, Utrecht, the Netherlands, between July 15, 2017, and July 31, 2020. The primary endpoints were the specificity and sensitivity of ECG as a diagnostic tool for LVH, with echocardiography serving as the reference method. Among the 329 participants, we identified 70 individuals (21.3%) with true LVH based on echocardiography. The ECG displayed a sensitivity of 47.9% and a specificity of 75.3%. Moreover, the area under the receiver operating characteristics curve was 0.604. In conclusion, ECG demonstrates limited value in identifying LVH. Considering the importance of accurately assessing HMOD for treatment optimization of hypertension, the role of ECG as a diagnostic tool for LVH is, therefore, questionable. Instead, we recommend employing standard echocardiography as a more reliable diagnostic.
Keyphrases
- left ventricular
- blood pressure
- heart rate
- hypertensive patients
- heart rate variability
- hypertrophic cardiomyopathy
- cardiac resynchronization therapy
- heart failure
- acute myocardial infarction
- mitral valve
- left atrial
- aortic stenosis
- computed tomography
- pulmonary hypertension
- primary care
- healthcare
- oxidative stress
- ejection fraction
- newly diagnosed
- combination therapy
- prognostic factors
- aortic valve
- replacement therapy
- emergency department
- atrial fibrillation
- quality improvement
- mesenchymal stem cells
- arterial hypertension
- cell therapy
- drug induced