Left ventricular mass is a strong predictor of cardiovascular disease (CVD), and magnetic
resonance imaging (MRI) of the heart is a standard of reference for left ventricular
mass measurement. Ethnicity is believed to affect electrocardiographic (ECG) performance.
We evaluated the diagnostic and prognostic performance of ECG for left ventricular
hypertrophy (LVH) as defined by MRI in relationship to ethnicity.
Data were analyzed from 4,967 participants (48% men, mean age 62 +/- 10 years; 39%
white, 13% Chinese, 26% African American, 22% Hispanic) enrolled in the Multi-Ethic
Study of Atherosclerosis (MESA) who were followed for a median of 4.8 years for incident
CVD.
Thirteen traditional ECG-LVH criteria were assessed, and showed overall and ethnicity-specific
low sensitivity (10%-26%) and high specificity (88%-99%) in diagnosing MRI-defined
LVH. Ten of 13 ECG-LVH criteria showed superior sensitivity and diagnostic performance
in African Americans as compared with whites (P = .02-.001). The sum of amplitudes
of S wave in V(1), S wave in V(2), and R wave in V(5) (a MESA-specific ECG-LVH criterion)
offered higher sensitivity (40.4%) compared with prior ECG-LVH criteria while maintaining
good specificity (90%) and diagnostic performance (receiver operating characteristic
area = 0.65). In fully adjusted models, only the MESA-specific ECG-LVH criterion,
Romhilt-Estes score, Framingham score, Cornell voltage, Cornell duration product,
and Framingham-adjusted Cornell voltage predicted increased CVD risk (P < .05).
Electrocardiography has low sensitivity but high specificity for detecting MRI-defined
LVH. The performance of ECG for LVH detection varies by ethnicity, with African Americans
showing higher sensitivity and overall performance compared with other ethnic groups.
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