Prevalence of electrocardiographic and echocardiographic LVH in a general population in northern italy. The vobarno study

Background: A large number of studies have demonstrated that left ventricular hypertrophy (LVH) detected with standard electroand echocardiography is an independent predictor of future cardiovascular complications in various subsets of patients. Due its low cost and wide availability electrocardiography represents the first line test for the assessment of cardiac organ damage in hypertensive patients. However a significant limitation is represented by its low sensitivity in detecting LVH. Aim of this study was to evaluate the prevalence of LVH detected by electroor echocardiography and the relationship between these two measures in a general population sample(Vobarno study). Methods: A total of 385 subjects (mean age 57 10years,44%males,64% hypertensives,44% overweight and 16%obese)underwent clinical examination with blood pressure measurement,standard laboratory examinations,a 12 leads electrocardiogram standard and standard echocardiography.EKGLVH was defined as the presence of a Sokolow-Lyon voltage 38 mm and/ or a Cornell voltage QRS duration productu003e2440 mm*msec and/or R in aVL;Echo-LVH was defined as LVMu003e50 g/m2.7 in men and 47g/m2.7 in women. Results: LVH prevalence was 5.1% and 16.3% with EKG and Echo,respectively.LVH was detected by both methods only in 2.0% of patients.The prevalence of EKG-LVH was 1.7% with Sokolow-Lyon voltage,4.2% with Cornell product and 5.1% with both EKG criteria.In hypertensives the prevalence of LVH was significantly greater than normotensives(6.8% vs 2.2% with EKG-LVH and 22.7% vs 9.6% with Echo).The concordance of the two techniques in identifying patients with LVH was only partial,and in particular,among patients with EKG-LVH a significant proportion(39%) did not have echo-LVH.However,patients with EKG-LVH but without Echo-LVH had greater LV mass index(39.9 vs 34.4 gr/m2.7,pu003c0.01) and worse systolic and diastolic function (midwall fractional shortening:17.3 vs 19.5; E/Em 10.6 vs 8.1,all pu003c0.01)as compared with those without both EKG and Echo-LVH.A positive correlation was observed between LVMI and Sokolow-Lyon voltage(r1⁄40.13,pu003c0.015),Cornell product(r1⁄40.22,pu003c0.001),Cornell voltage(r1⁄40.45,pu003c0.001)and R in aVL(r1⁄40.38,pu003c0.001). Conclusions: Our data confirm the greater sensibility of echocardiography examination for detection of LVH.The presence of EKG-LVH is associated with greater LVMI and worse systolic and diastolic function,even in the absence of clear-cut echo-LVH.Our results confirm the importance of identifying cardiac organ damage with both methods for a better stratification of cardiovascular risk.