Electrocardiographic Criteria for Left Ventricular Hypertrophy in Asians Differs from Criteria Derived from Western Populations--Community-based Data from an Asian Population

<p><b>INTRODUCTION</b>Electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH), such as the Cornell and Sokolow-Lyon voltage criteria were derived from Western populations. However, their utility and accuracy for diagnosing echocardiographic LVH in Asian populations is unclear. The objective of this study was to assess the accuracy of ECG criteria for LVH in Asians and to determine if alternative gender-specific ECG cut-offs may improve its diagnostic accuracy.</p><p><b>MATERIALS AND METHODS</b>ECG and echocardiographic assessments were performed on 668 community-dwelling Asian adults (50.9% women; 57 ± 10 years) in Singapore. The accuracy of ECG voltage criteria was compared to echocardiographic LVH criteria based on the American Society of Echocardiography guidelines, and Asian ethnicity and gender-specific partition values.</p><p><b>RESULTS</b>Echocardiographic LVH was present in 93 (13.6%) adults. Cornell criteria had low sensitivity (5.5%) and high specificity (98.9%) for diagnosing LVH. Modified gender specific cut-offs (18 mm in women, 22 mm in men) improved sensitivity (8.8% to 17.5%, 0% to 14.7%, respectively) whilst preserving specificity (98.2% to 94.2%, 100% to 95.8%). Similarly, Sokolow-Lyon criteria had poor sensitivity (7.7%) and high specificity (96.1%) for diagnosing LVH. Lowering the cut-off value from 35 mm to 31 mm improved the sensitivity in women from 3.5% to 14% while preserving specificity at 94.2%. A cut-off of 36 mm was optimal in men (sensitivity of 14.7%, specificity of 95.5%).</p><p><b>CONCLUSION</b>Current ECG criteria for LVH derived in Western cohorts have limited sensitivity in Asian populations. Our data suggests that ethnicity- and gender-specific ECG criteria may be needed.</p>

Clinically compressed digital echocardiography: a patient-safe alternative to videotape review

<p><b>INTRODUCTION</b>Digital storage of echocardiographic data offers logistical advantages over videotape archival. However, limited information is available on the accuracy of clinically compressed digitised examinations, an important consideration for patient safety.</p><p><b>MATERIALS AND METHODS</b>Transthoracic echocardiograms of 520 consecutive patients were prospectively acquired digitally and on videotape. Two echocardiologists, in consensus, reported studies in both formats sequentially. Using the videotape as a reference, the significance of any reported differences was graded from both imaging and clinical standpoints, and the reasons for these differences identified.</p><p><b>RESULTS</b>From an imaging perspective, differences between digital and videotaped studies were absent or minor in 459 cases (88%), fairly significant in 55 (11%) and very significant in 6 (1%). The main reasons for the observed differences were inadequate acquisition of optimal views (59%), an insufficient number of acquired cardiac cycles (25%) and suboptimal image quality (9%). These differences were considered to be of possible or definite clinical importance in 21 (4%) and 8 (2%) cases, respectively. In multinominal logistic regression models, the only independent predictor of significant difference between digitised and videotaped images was study complexity. Regardless of case complexity, most diagnostic errors arising from digital review were attributable to technical failure rather than observer error.</p><p><b>CONCLUSIONS</b>The potential for important errors arising from exclusive reporting of clinically compressed digital echocardiograms is small. Digital echocardiography, as practiced in a routine clinical setting, offers a patient-safe alternative to videotape review.</p>