Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
J Am Coll Cardiol. 2014 Feb 25;63(7):672-81. doi: 10.1016/j.jacc.2013.08.1633. Epub 2013 Sep 28.

Validity of the surface electrocardiogram criteria for right ventricular hypertrophy: the MESA-RV Study (Multi-Ethnic Study of Atherosclerosis-Right Ventricle).

Author information

  • 1Department of Medicine, Division of Cardiology, University of California, San Francisco, California.
  • 2Department of Medicine, Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • 3Departments of Epidemiology and Prevention and Internal Medicine, Cardiology Section, Epidemiological Cardiology Research Center (EPICARE), Wake Forest University Health Sciences, Winston-Salem, North Carolina.
  • 4Radiology and Imaging Sciences, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health/Clinical Center, Bethesda, Maryland.
  • 5Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • 6Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • 7Division of Cardiology, Department of Internal Medicine, Wake Forest University Health Sciences, Winston-Salem, North Carolina.
  • 8Department of Medicine, Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: kawut@upenn.edu.

Abstract

OBJECTIVES:

The study aimed to assess the diagnostic properties of electrocardiographic (ECG) criteria for right ventricular hypertrophy (RVH) measured by cardiac magnetic resonance imaging (cMRI) in adults without clinical cardiovascular disease.

BACKGROUND:

Current ECG criteria for RVH were based on cadaveric dissection in small studies.

METHODS:

MESA (Multi-Ethnic Study of Atherosclerosis) performed cMRIs with complete right ventricle (RV) interpretation on 4,062 participants without clinical cardiovascular disease. Endocardial margins of the RV were manually contoured on diastolic and systolic images. The ECG screening criteria for RVH from the 2009 American Heart Association Recommendations for Standardization and Interpretation of the ECG were examined in participants with and without left ventricular (LV) hypertrophy or reduced ejection fraction. RVH was defined using sex-specific normative equations based on age, height, and weight.

RESULTS:

The study sample with normal LV morphology and function (n = 3,719) was age 61.3 ± 10.0 years, 53.5% female, 39.6% Caucasian, 25.5% African American, 21.9% Hispanic, and 13.0% Asian. The mean body mass index was 27.9 ± 5.0 kg/m(2). A total of 6% had RVH, which was generally mild. Traditional ECG criteria were specific (many >95%) but had low sensitivity for RVH by cMRI. The positive predictive values were not sufficiently high as to be clinically useful (maximum 12%). The results did not differ based on age, sex, race, or smoking status, or with the inclusion of participants with abnormal LV mass or function. Classification and regression tree analysis revealed that no combination of ECG variables was better than the criteria used singly.

CONCLUSIONS:

The recommended ECG screening criteria for RVH are not sufficiently sensitive or specific for screening for mild RVH in adults without clinical cardiovascular disease.

Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

electrocardiogram; magnetic resonance imaging; right ventricular hypertrophy

PMID:
24080107
[PubMed - indexed for MEDLINE]
PMCID:
PMC3944058
[Available on 2015/2/25]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Write to the Help Desk