Features of arterial hypertension patients with discrepancies in vectorcardiographic and echocardiographic conclusions about the presence of left ventricular hypertrophy [Original Article]

Aim. To determine the features of patients with arterial hypertension (AH) with a discrepancy of electrocardiographic, including vectorcardiographic (VCG) and echocardiographic conclusions about the presence of left ventricular hypertrophy (LVH). Materials and methods. 140 patients with AH were examined (mean age 59.8±12.0 years, 33.6% of men). The Sokolov- Lyon criterion, the Cornell product, the sum of the amplitudes of the R wave in lead X and the S wave in lead Z of the synthesized vectorcardiogram (RX+SZ) and the amplitude of the maximal QRS vector (MQRS) were analyzed. Left ventriclular myocardial mass (LVMM) was calculated using the ASE formula, LVMM/height2.7 more than 44 g/m2.7 in women and more than 48 g/m2.7 in men was considered a criterion for LVH.Results. In patients with AH, pathological RX+SZ and MQRS values were significantly more frequent compared with the Sokolov-Lyon criterion and the Cornell product. Pathological values of RX+SZ and MQRS were met both in patients with an increased and with a normal indexed LVMM. Patients with "true-positive" VCG findings compared with "false-negative" had significantly larger values of the relative wall thickness, LVMM and indexed LVMM. Patients with “false positive” VCG findings compared with “true-negative” were more likely to have left ventricular diastolic dysfunction (90% and 68%, respectively). Patients with the presence of VCG criteria for LVH, both with normal and with an increased indexed LVMM, were characterized by higher values of systolic blood pressure and higher values of the QRS duration. Conclusion. In patients with arterial hypertension, pathological values of vectorcardiographic indices were significantly more frequent compared with the Sokolov-Lyon criterion and the Cornell product. VCG indices allowed to separate groups of patients with the presence and absence of diastolic dysfunction of the left ventricle, as well as groups of patients with normal and elevated values of systolic blood pressure.

arterial hypertension, left ventricular hypertrophy, electrocardiography, synthesized vectorcardiogram, echocardiography

1. Schillaci G, Battista F, Pucci G. A review of the role of electrocardiography in the diagnosis of left ventricular hypertrophy in hypertension. J Electrocardiol 2012; 45 (6): 617-23. DOI: 10.1016/j.jelectrocard.2012.08.051

2. Bacharova L, Estes H, Bang L et al. The first statement of the Working Group on Electrocardiographic Diagnosis of Left Ventricular Hypertrophy. J Electrocardiol 2010; 43 (3): 197-9. DOI: 10.1016/j.jelectrocard.2010.03.003

3. Bacharova L, Estes E.H, Bang L.E et al. Second statement of the working group on electrocardiographic diagnosis of left ventricular hypertrophy. J Electrocardiol 2011; 44 (5): 568-70. DOI: 10.1016/j.jelectrocard.2011.06.005

4. Bacharova L, Estes H.E, Schocken D.D et al. The 4th Report of the Working Group on ECG diagnosis of Left Ventricular Hypertrophy. J Electrocardiol 2017; 50 (1): 11-5. DOI: 10.1016/j.jelectrocard.2016.11.003

5. Чазова И.Е., Жернакова Ю.В. от имени экспертов. Клинические рекомендации. Диагностика и лечение артериальной гипертонии. Системные гипертензии. 2019; 16 (1): 6-31. DOI: 10.26442/2075082X.2019.1.190179 @@Chazova I.E., Zhernakova Yu.V. on behalf of the experts. Clinical guidelines. Diagnosis and treatment of arterial hypertension. Systemic Hypertension. 2019; 16 (1): 6-31. DOI: 10.26442/2075082X.2019.1.190179 (in Russian)

6. Lang R.M, Badano L.P, Mor-Avi V et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28 (1): 1-39.e14. DOI: 10.1016/j.echo.2014.10.003

7. Chirinos J.A, Segers P, De Buyzere M.L et al. Left ventricular mass: allometric scaling, normative values, effect of obesity, and prognostic performance. Hypertension 2010; 56 (1): 91-8. DOI: 10.1161/ HYPERTENSIONAHA.110.150250

8. De Simone G, Kizer J.R, Chinali M et al; Strong Heart Study Investigators. Normalization for body size and population-attributable risk of left ventricular hypertrophy: the Strong Heart Study. Am J Hypertens 2005; 18 (2 Pt 1): 191-6. DOI: 10.1016/j.amjhyper.2004.08.032

9. Estes E.H, Zhang Z.M, Li Y et al. Individual components of the Romhilt-Estes left ventricular hypertrophy score differ in their prediction of cardiovascular events: The Atherosclerosis Risk in Communities (ARIC) study. Am Heart J 2015; 170 (6): 1220-6. DOI: 10.1016/j.ahj.2015.09.016

10. Bacharova L, Chen H, Estes E.H et al. Determinants of discrepancies in detection and comparison of the prognostic significance of left ventricular hypertrophy by electrocardiogram and cardiac magnetic resonance imaging. Am J Cardiol 2015; 115 (4): 515-22. DOI: 10.1016/j.amjcard.2014.11.037

11. Macfarlane W, Okin P.M, Lawrie T.D.V, Milliken J.A. Enlargement and Hypertrophy. In: PW Macfarlane, A Van Oosterom, O Pahlm et al., editors. Comprehensive electrocardiology. London: Springer Verlag, 2011; p. 607-44. doi.org/10.1007/978-1-84882-046-3

12. Терегулов Ю.Э., Терегулова Е.Т., Маянская С.Д., Латипова З.К. Ремоделирование левого желудочка: геометрические и электрокардиографические сопоставления. Практ. медицина. 2014; 3 (79): 149-54. @@Teregulov Iu.E., Teregulova E.T., Maianskaia S.D., Latipova Z.K. Remodelirovanie levogo zheludochka: geometricheskie i elektrokardiograficheskie sopostavleniia. Prakt. meditsina. 2014; 3 (79): 149-54 (in Russian)

13. Овчинников А.Г., Потехина А.В., Ожерельева М.В., Агеев Ф.Т. Дисфункция левого желудочка при гипертоническом сердце: современный взгляд на патогенез и лечение. Кардиология. 2017; 57 (S2): 367-82. DOI: 10.18087/cardio.2393 @@Ovchinnikov A.G., Potekhina A.V., Ozherel'eva M.V., Ageev F.T. Disfunktsiia levogo zheludochka pri gipertonicheskom serdtse: sovremennyi vzgliad na patogenez i lechenie. Kardiologiia. 2017; 57 (S2): 367-82. DOI: 10.18087/cardio.2393 (in Russian)

14. Nagueh S.F, Smiseth O.A, Appleton C.P et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016; 29 (4): 277-314. DOI: 10.1016/j.echo.2016.01.011

15. Maanja M, Wieslander B, Schlegel T.T et al. Diffuse Myocardial Fibrosis Reduces Electrocardiographic Voltage Measures of Left Ventricular Hypertrophy Independent of Left Ventricular Mass. J Am Heart Assoc 2017; 6 (1). pii: e003795. DOI: 10.1161/JAHA.116.003795

16. Bacharova L, Szathmary V, Potse M, Mateasik A. Computer simulation of ECG manifestations of left ventricular electrical remodeling. J Electrocardiol 2012; 45 (6): 630-4. DOI: 10.1016/j.jelectrocard.2012.07.009