aDepartment of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil bDivisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden cDepartment of Echocardiography dDepartment of Nutrition, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil eCenter for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
J Hypertens. 2014 Feb;32(2):439-45. doi: 10.1097/HJH.0000000000000026.
Left ventricular hypertrophy (LVH) is a prevalent condition in chronic kidney disease (CKD) very often underdiagnosed and misdiagnosed. Electrocardiography (ECG) is an easily accessible LVH diagnostic tool. We evaluated the usefulness of commonly applied ECG criteria for LVH diagnosis in CKD patients.
Cross-sectional evaluation of 253 nondialysis-dependent CKD stages 3-5 patients (61 [53-67] years; 65% men). Left ventricular mass (LVM) was assessed by echocardiography (ECHO). ECG was performed to assess Cornell voltage and Sokolow-Lyon voltage and their products (Cornell product and Sokolow-Lyon product, respectively).
The prevalence of LVH ranged from 72 to 89% depending on ECHO criteria used. Cornell product showed the best correlation with ECHO-estimated LVM (ρ = 0.41; P <0.001). Across sex-specific tertiles of ECHO-LVM, ECG criteria increased and patients were more often hypertensive, obese, fluid overloaded, inflamed, and with higher albuminuria. Cornell product showed the strongest association with ECHO-LVM in crude and adjusted regression models, and the higher predictive performance for all the ECHO-based LVH definitions. However, when applying literature-based ECG cut-offs for LVH diagnosis, Sokolow-Lyon product showed a higher specificity. The agreement between ECG criteria cut-offs and ECHO-based definitions of LVH was in general poor, and the number of patients reclassified correctly by ECHO ranged from 77 to 94%.
Our data suggest that ECG alone is a weak indicator of LVH, and do not support its routine use as a unique tool in the screening of LVH in CKD patients. Further studies are needed to confirm these results and to try establishing adequate cut-offs for LVH diagnosis in this population.
左心室肥厚（LVH）是慢性肾脏病（CKD）中一种常见的病症，常常被漏诊和误诊。心电图（ECG）是一种易于获得的 LVH 诊断工具。我们评估了常用于 CKD 患者 LVH 诊断的常见 ECG 标准的有用性。
对 253 名非透析依赖的 CKD 3-5 期患者（61 [53-67] 岁；65%为男性）进行横断面评估。通过超声心动图（ECHO）评估左心室质量（LVM）。进行心电图检查以评估 Cornell 电压和 Sokolow-Lyon 电压及其乘积（分别为 Cornell 乘积和 Sokolow-Lyon 乘积）。
根据使用的 ECHO 标准，LVH 的患病率从 72%到 89%不等。Cornell 乘积与 ECHO 估计的 LVM 相关性最好（ρ=0.41；P<0.001）。在 ECHO-LVM 的性别特异性三分位组中，ECG 标准增加，患者更常患有高血压、肥胖、体液超负荷、炎症和更高的蛋白尿。Cornell 乘积在未经调整和调整后的回归模型中与 ECHO-LVM 具有最强的关联，并且对所有基于 ECHO 的 LVH 定义都具有更高的预测性能。然而，当应用基于文献的 ECG 切点进行 LVH 诊断时，Sokolow-Lyon 乘积显示出更高的特异性。ECG 标准切点与基于 ECHO 的 LVH 定义之间的一致性通常较差，通过 ECHO 重新分类的患者数量从 77%到 94%不等。
我们的数据表明，ECG 本身是 LVH 的一个弱指标，不支持将其作为 CKD 患者 LVH 筛查的唯一工具常规使用。需要进一步的研究来证实这些结果，并尝试为该人群确定 LVH 诊断的适当切点。
