ASSESSMENT OF LEFT VENTRICULAR HYPERTROPHY IN PATIENTS WITH ESSENTIAL ARTERIAL HYPERTENSION IN A GENERAL PRACTICE
Keywords:
arterial hypertension, left ventricular hypertrophy, target organ, ECG, family physicianAbstract
Background. The heart is a target organ in arterial hypertension. Echocardiography is the most valuable noninvasive method to assess the left ventricular hypertrophy. Patients with left ventricular hypertrophy constitute a group with high cardiovascular risk. Unfortunately, it is not affordable to all hypertensive patients treated in general practice. ECG still remains the basic method to evaluate the left ventricular hypertrophy. A selection of the most sensitive ECG criteria to evaluate left ventricular hypertrophy might improve the sensitivity of the method and thus recognize a sufficient proportion of the hypertensive patients with left ventricular hypertrophy, confirmed by echocardiography.
Patients and methods. We included 62 consecutive patients (31 male and 31 female) with essential arterial hypertension, treated in a single general practice. We made anamnesis, a complete clinical examination with eye fundi examination, usual laboratory examinations, 12-lead ECG and echocardiography. We applied the ECG criteria to evaluate left ventricular hypertrophy (Sokolow-Lyon index > 38 mm, Cornell product > 2440 mm*ms) and echocardiographic criteria (left ventricular mass for men at least 125 g/m2 and for women at least 110 g/m2).
Results. We found left ventricular hypertrophy in 13 (21.0%) patients by using the combination of both ECG criteria and in 39 (62.9%) by echocardiography. The sensitivity of the combined ECG criteria was 25.6%, the sensitivity of SokolowLyon index was 12.8% and the sensitivity of Cornell product was 17.9%. The specificity of Sokolow-Lyon index was 83%, Cornell product had 78% specificity and the combination of both criteria had specificity of 100%. The left ventricular hypertrophy confirmed by echocardiography was more prevalent in female patients (p = 0.035) and it showed statistically significant correlation with higher values of Sokolow-Lyon index and Cornell product (p < 0.0005).
Conclusions. The combination of Sokolow-Lyon index and Cornell product yields higher sensitivity than each of them alone and enables us to recognize a higher percentage of hypertensive patients with actual left ventricular hypertrophy. Values of applied ECG criteria which are closer to the limit values signify a higher possibility for the left ventricular hypertrophy.
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