Format

Send to

Choose Destination
Am J Hypertens. 2015 Aug;28(8):1038-48. doi: 10.1093/ajh/hpu268. Epub 2015 Jan 14.

R Wave in aVL Lead is a Robust Index of Left Ventricular Hypertrophy: A Cardiac MRI Study.

Author information

1
Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Génomique Fonctionnelle de l'Hypertension artérielle, Villeurbanne, France; Hôpital Nord-Ouest, Villefranche-sur-Saône, France;
2
Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France;
3
Cardiology Department, Hôpital Nord-Ouest, Villefranche-sur-Saône, France;
4
Génomique Fonctionnelle de l'Hypertension artérielle, Villeurbanne, France; Hôpital Nord-Ouest, Villefranche-sur-Saône, France;
5
Radiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.

Abstract

BACKGROUND:

In patients free from overt cardiac disease, R wave in aVL lead (RaVL) is strongly correlated with left ventricular mass index (LVMI) assessed by transthoracic echocardiography. The aim of the present study was to extend this finding to other settings (cardiomyopathy or conduction disorders), by comparing ECG criteria of left ventricular hypertrophy (LVH) to cardiac MRI (CMR).

METHODS:

In 501 patients, CMR and ECG were performed within a median-period of 5 days. CMR LVH cut-offs used were 83 g/m2 in men and 67 g/m2 in women.

RESULTS:

RaVL was independently correlated with LVMI in patients with or without myocardial infarction (MI) (N = 300 and N = 201, respectively). SV3 was independently correlated with LVMI and LV enlargement only in patients without MI. In the whole cohort, RaVL had area under receiver-operating characteristic curve of 0.729 (specificity 98.3%, sensitivity 19.6%, optimal cut-off 1.1 mV). The performance of RaVL was remarkable in women, in Caucasians, and in the presence of right bundle branch block. It decreased in case of MI. Overall, it is proposed that below 0.5 mV and above 1.0 mV, RaVL is sufficient to exclude or establish LVH. Between 0.5 and 1 mV, composite indices (Cornell voltage or product) should be used. Using this algorithm allowed classifying appropriately 85% of the patients.

CONCLUSIONS:

Our results showed that RaVL is a good index of LVH with a univocal threshold of 1.0 mV in various clinical conditions. SV3 may be combined to RaVL in some conditions, namely LV enlargement to increase its performance.

KEYWORDS:

ECG; R wave in aVL lead.; blood pressure; cardiac MRI; hypertension; left ventricular hypertrophy

PMID:
25588700
DOI:
10.1093/ajh/hpu268
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center