Arterial hypertension is a common disease with high prevalence in the general population. Left ventricular hypertrophy LVH is an independent risk factor in arterial hypertension. We assessed the diagnostic performance of the SLI in a cohort of a large general population. To assess the impact of the body-mass-index BMI , we performed interaction analyses. The relations were strongest when obese subjects were taken into account. A recent publication reported a prevalence of
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Arterial hypertension is a common disease with high prevalence in the general population. Left ventricular hypertrophy LVH is an independent risk factor in arterial hypertension.
We assessed the diagnostic performance of the SLI in a cohort of a large general population. To assess the impact of the body-mass-index BMI , we performed interaction analyses. The relations were strongest when obese subjects were taken into account. A recent publication reported a prevalence of There is increasing evidence of regional differences with a higher prevalence of arterial hypertension in the eastern part of Germany [ 3 ].
In patients with arterial hypertension, LVH initially serves as a compensatory mechanism of the heart to deal with the increased arterial pressure. Increase of LVM is an independent risk factor in arterial hypertension. Thus, for patients suffering from arterial hypertension the diagnosis of a possibly existing LVH is of essential importance. From the early beginnings of LVH diagnosis by means of Chest X-ray [ 5 ], nowadays, transthoracic echocardiography or magnetic resonance imaging MRI became gold standards to assess left ventricular size and mass [ 1 ].
Based on myocardial wall thickness, LVM can be estimated easily, however, echocardiography usually has to be performed by a trained cardiologist. A transfer of the patient to a specialist is therefore usually mandatory, which is associated with increased costs and waiting times for the patient.
Consequently, these circumstances weaken its value as a practical screening examination in the general population. For a long time, the lead-electrocardiogram ECG is considered a cost- and time-effective alternative in comparison to echocardiography or MRI for detecting LVH by using various indices.
The most popular index was developed and published in by Maurice Sokolow and Thomas P. Lyon, and is calculated as the sum of the amplitudes of the S-wave in V 1 and the R-wave in V 5 or V 6 whichever is larger [ 6 ]. In current non-cardiologic, general practitioner care routine, the Sokolow-Lyon index SLI by a threshold of 3. All of the hypertrophy indices, in particular the SLI, show high specificity but low sensitivity to varying degrees, which weakens its diagnostic value [ 5 ].
However, most of the data reported were derived from arterial hypertension patient collectives, while reliable data from population-based cohort studies are still missing. The aim of this study was to investigate the diagnostic performance of the Sokolow-Lyon index for diagnosis of LVH in a large cohort of the general population. A multi-step recruitment strategy aimed to achieve a high response rate. All data used in this cross sectional analysis resulted from the baseline examination of the study.
The baseline examination took place between December and January Furthermore, anthropometric, hemodynamic blood pressure, ankle-brachial-index and heart rate , electrocardiographic and echocardiographic data were obtained in every participant.
Transthoracic Doppler echocardiographic examinations were conducted and evaluated by specially trained and certified physicians. All echocardiographers underwent the same dedicated study certification procedures. The mean intra-observer bias for the M-mode examinations varied between 0. To calculate the LVM, we used the formula of the American Society of Echocardiography ASE-cube formula , which is in accordance with international guidelines [ 1 , 12 , 13 ]. We also assessed the component variables of the formula, which in the clinical routine often serve as surrogate for LVH: septal wall thickness at end-diastole SWTd , left ventricular posterior wall thickness at end-diastole PWTd and the left-ventricular internal dimension at end-diastole LVIDd.
The measurement of all LVM compound variables was done in the m-mode of the parasternal long axis. The precision used for calculation was 0. We used linear regression models to assess the association of echocardiographic components with SLI. Categorizing the SLI cut off: 3. Furthermore, areas under the receiver operation characteristics curves AUCs were computed.
We assessed violations of the linearity assumption using restricted cubic splines, which indicated that linearity was an adequate fit to the data. Linear regression of echocardiographic parameters on the Sokolow-Lyon index within considered BMI categories, and respective interaction analyses.
We performed a sensitivity analysis where we adjusted for age and sex only in order to assess the confounding effect of these two parameters results presented in the appendix. Data of the participants of the baseline investigation were included in the statistical analysis. Baseline data of the CARLA study, including prevalences of cardiovascular risk factors like arterial hypertension, are published elsewhere [ 8 , 17 ]. Mean age was The mean SLI was 2. In the whole study collective, the mean systolic blood pressure SBP was In men, mean SBP was In comparison, women had a mean SBP of Area under the receiver operator characteristics curve AUC of When we adjusted for age and sex only, estimates were not relevantly changed see appendix.
These relations did only depend on the BMI when obese subjects were taken into account. Furthermore, we found a very high specificity, but low sensitivity of SLI to diagnose LVH by the common threshold of 3.
In consistence, a mean LVMI of However, considering the former recommendations for echocardiographic quantification, this corresponds to a mild degree of LVH [ 13 ]. Several publications suggested a negative influence of obesity on the predictive value of the SLI [ 21 — 25 ].
However, like in the whole sample, this association appeared to be mainly driven by the association of SLI and LVIDd - implicating, that SLI is primarily useful as a tool to diagnose a more eccentric type of LVH in our collective, especially in obese subjects.
This might support recent findings which also implicate a higher prevalence of eccentric LVH prevailing over concentric LVH in obese patients, which might be explained by the elevated cardiac output and increased plasma volume in those patients [ 26 ]. The poor performance of the SLI has already been reported in several publications over last decades, but predominantly in hypertensive or old patient collectives [ 19 , 20 , 27 — 29 ].
In our study, we found similar results in a large general population. This study has some limitations. At first, this was a retrospective analysis of prospective obtained data.
All patients received a transthoracical echocardiography, which is the recommended examination for detecting LVH in recent guidelines [ 1 ]. Although it has to be stated, that in obese patients quality of echocardiographic assessments often can be poor. In conclusion, the Sokolow-Lyon index is not suitable as a diagnostic screening test to identify patients at risk for LVH, in particular in non-obese subjects without eccentric LVH. Competing interests.
JS drafted the manuscript and participated in the statistical analyses. SN trained the study personnel, coordinates the study, helped designing the study and drafting the manuscript.
UMW helped designing the study and drafting the manuscript. KW designed major parts of the study and helped drafting the manuscript. AK helps coordinate the study, participated in the statistical analyses and helped drafting the manuscript. KHG conceived of the study, designed major parts of the study, trained the study personnel and participated in the statistical analyses.
MR helped drafting the manuscript. JH helped designing the study and drafting the manuscript. DM performed the statistical analyses and helped drafting the manuscript. All authors read and approved the final manuscript. Sebastian Nuding, Email: ed. Karl Werdan, Email: ed. Alexander Kluttig, Email: ed. Martin Russ, Email: ed. Karin H. Greiser, Email: ed. Jan A. Kors, Email: ln. Johannes Haerting, Email: ed. Daniel Medenwald, Email: ed. National Center for Biotechnology Information , U.
BMC Cardiovasc Disord. Published online Jul Greiser , Jan A. Kors , Johannes Haerting , and Daniel Medenwald. Author information Article notes Copyright and License information Disclaimer.
Corresponding author. Received Apr 3; Accepted Jul 7. Abstract Background Arterial hypertension is a common disease with high prevalence in the general population. Echocardiographic assessment Transthoracic Doppler echocardiographic examinations were conducted and evaluated by specially trained and certified physicians. Table 1 Basic characteristics. Open in a separate window. Table 3 Linear regression of echocardiographic parameters on the Sokolow-Lyon index within considered BMI categories, and respective interaction analyses.
Results Data of the participants of the baseline investigation were included in the statistical analysis. Table 2 Linear regression of echocardiographic parameters on the Sokolow-Lyon index. Conclusions In conclusion, the Sokolow-Lyon index is not suitable as a diagnostic screening test to identify patients at risk for LVH, in particular in non-obese subjects without eccentric LVH. Appendix Table 4 Linear regression of echocardiographic parameters on the Sokolow-Lyon index.
Left ventricular hypertrophy
Na amostra total tab. Gasperin e cols. Alfakih e cols. Prognostic value of a new electrocardiographic method for diagnosis of left ventricular hypertrophy. J Am Coll Cardiol.
The QRS voltage increases with both thickening of the wall pressure overload and dilatation of the chamber volume overload of the left ventricle. ECG detection of left ventricular hypertrophy: the simpler, the better? RaVL is a limb voltage, well aligned with the depolarization axis of the left ventricle. These features probably result from the fact that RaVL does not require thoracic leads, which is undoubtedly a source of variability, particularly in women.
Left ventricular hypertrophy LVH is thickening of the heart muscle of the left ventricle of the heart , that is, left-sided ventricular hypertrophy. While ventricular hypertrophy occurs naturally as a reaction to aerobic exercise and strength training , it is most frequently referred to as a pathological reaction to cardiovascular disease , or high blood pressure. While LVH itself is not a disease, it is usually a marker for disease involving the heart. Causes of increased afterload that can cause LVH include aortic stenosis , aortic insufficiency and hypertension. Primary disease of the muscle of the heart that cause LVH are known as hypertrophic cardiomyopathies , which can lead into heart failure.