Okin Peter M, Wright Jackson T, Nieminen Markku S, Jern Sverker, Taylor Anne L, Phillips Robert, Papademetriou Vasilio, Clark Luther T, Ofili Elizabeth O, Randall Otelio S, Oikarinen Lasse, Viitasalo Matti, Toivonen Lauri, Julius Stevo, Dahlöf Björn, Devereux Richard B
Department of Medicine, Weill Medical College of Cornell University, New York, New York 10021, USA.
Am J Hypertens. 2002 Aug;15(8):663-71. doi: 10.1016/s0895-7061(02)02945-x.
African Americans have greater precordial QRS voltages than whites, with concomitant higher prevalences of electrocardiographic (ECG) left ventricular hypertrophy (LVH) and lower specificity of ECG LVH criteria for the identification of anatomic hypertrophy. However, the high mortality associated with LVH in African American patients makes more accurate ECG detection of LVH in these patients a clinical priority.
Electrocardiograms and echocardiograms were obtained at study baseline in 120 African American and 751 white hypertensive patients enrolled in the Losartan Intervention For Endpoint (LIFE) echocardiographic substudy. The ECG LVH was determined using Sokolow-Lyon, 12-lead sum, and Cornell voltage criteria. Echocardiographic LVH was defined by LV mass indexed to height(2.7) >46.7 g/m(2.7) in women and >49.1 g/m(2.7) in men.
After adjusting for ethnic differences in LV mass, body mass index, sex, and prevalence of diabetes, mean Sokolow-Lyon and 12-lead sum of voltage were significantly higher, but Cornell voltage was lower, in African Americans than in whites. As a consequence of these differences, when identical partition values were used in both ethnic groups, Sokolow-Lyon and 12-lead voltage criteria had lower specificity in African Americans than whites (44% v 69%, P = .007 and 44% v 59%, P = .10) but had greater sensitivity in African Americans (51% v 27%, P < .001 and 62% v 45%, P = .003). In contrast, Cornell voltage specificity was higher (78% v 62%, P = .09) but sensitivity was slightly lower (49% v 57%, P = 0.16) in African Americans. However, when overall test performance was compared using receiver operating curve analyses that were independent of partition value selection, ethnic differences in test performance disappeared, with no differences in accuracy of any of the ECG voltage criteria for the identification of LVH between African American and white hypertensive individuals.
When standard, non-ethnicity-specific thresholds for the identification of LVH are used, Sokolow-Lyon and 12-lead voltage overestimate and Cornell voltage underestimates the presence and severity of LVH in African American relative to white individuals. However, these apparent ethnic differences in test performance disappear when ethnic differences in the distribution of ECG LVH criteria are taken into account. These findings demonstrate that ethnicity-specific ECG criteria can equalize detection of anatomic LVH in African American and white patients.
非裔美国人的心前区QRS电压高于白人，同时心电图（ECG）左心室肥厚（LVH）的患病率更高，且ECG LVH标准用于识别解剖学肥厚的特异性较低。然而，非裔美国患者中与LVH相关的高死亡率使得更准确地通过ECG检测这些患者的LVH成为临床优先事项。
在参加氯沙坦干预终点（LIFE）超声心动图亚研究的120名非裔美国高血压患者和751名白人高血压患者的研究基线时获取心电图和超声心动图。使用索科洛 - 里昂、12导联总和及康奈尔电压标准来确定ECG LVH。超声心动图LVH的定义为女性身高（2.7）指数化的左心室质量>46.7 g/m（2.7），男性>49.1 g/m（2.7）。
在对左心室质量、体重指数、性别和糖尿病患病率的种族差异进行调整后，非裔美国人的平均索科洛 - 里昂和12导联电压总和显著高于白人，但康奈尔电压低于白人。由于这些差异，当在两个种族群体中使用相同的划分值时，索科洛 - 里昂和12导联电压标准在非裔美国人中的特异性低于白人（44%对69%，P = 0.007和44%对59%，P = 0.10），但在非裔美国人中的敏感性更高（51%对27%，P < 0.001和62%对45%，P = 0.003）。相比之下，康奈尔电压特异性在非裔美国人中更高（78%对62%，P = 0.09），但敏感性略低（49%对57%，P = 0.16）。然而，当使用独立于划分值选择的受试者工作特征曲线分析来比较总体测试性能时，测试性能的种族差异消失，非裔美国和白人高血压个体在识别LVH的任何ECG电压标准的准确性上没有差异。
当使用标准的、非种族特异性的LVH识别阈值时，相对于白人个体，索科洛 - 里昂和12导联电压高估了非裔美国人LVH的存在和严重程度，而康奈尔电压低估了。然而，当考虑到ECG LVH标准分布中的种族差异时，这些明显的测试性能种族差异消失。这些发现表明，种族特异性的ECG标准可以使非裔美国和白人患者解剖学LVH的检测均等化。
