Detection of left ventricular hypertrophy by different electrocardiographic criteria in clinical practice. Findings from the Sara study.

The objective of this study is to compare the validity of different product duration-based electrocardiographic criteria with the classical voltage criteria and to estimate the prevalence of left ventricular hypertrophy (LVH) for each criterion. Electro cardiographic criteria from 248 hypertensive patients attended in daily clinical practice were examined. Cornell and Sokolow-Lyon voltage indexes, Cornell and Sokolow-Lyon products, and Cornell and Sokolow-Lyon areas were determined. The presence of echocardiographic LVH was documented from the patients' clinical records. The proportion of patients with LVH detected by Cornell product was 27.3% vs. 12.9% by Cornell voltage, and 23.6% by Sokolow-Lyon product vs. 12.0% by Sokolow voltage. Both were p < 0.05. When QRS area criteria were applied, ECG-LVH was present in 32.7% (Cornell area) and 29.5% (Sokolow area) of the patients, respectively. When the composite of several criteria was applied, the detection of LVH with the combination of the Cornell product and the Sokolow-Lyon voltage index increased to 33% and with the combination of Cornell and Sokolow-Lyon products reached 39.3%. Globally, the patients diagnosed by voltage criteria were older, had higher systolic blood pressure (SBP) and a longer history of hypertension when compared to subjects diagnosed by product or area-based criteria. The Cornell and Sokolow-Lyon product and the QRS area-based criteria improve the detection of ECG-LVH in the hypertensive population. The composite of different criteria may be a useful strategy to further increase the diagnostic ability of ECG. The combinations of the Cornell product with the Sokolow voltage or with the Sokolow product appear to be the most efficient options.

Electrocardiographic left ventricular hypertrophy regression induced by an angiotensin receptor blocker-based regimen in daily clinical practice: the SARA study.

AIM: Clinical trials have proved that angiotensin receptor blockers (ARB) are more effective than other antihypertensive agents in reducing left ventricular hypertrophy (LVH); however, information about the efficacy of ARB on LVH regression in daily medical practice is scarce. The aim of the SARA study was to investigate the effect of an ARB on electrocardiographic LVH (ECG-LVH) in a hypertensive outpatient population attending clinical practice. METHODS: From 276 recruited patients with mild-to-moderate essential hypertension (245 uncontrolled, 31 newly diagnosed), 264 (age: 62.9+/-11.6 years; 51.2% women) completed the study and were valid for the analysis. The patients were treated for a 12-month period with a candesartan-based regimen [(8/16 mg+hydrochlorothiazide 12.5 mg+additional drugs to target BP<140/90 mmHg (<130/80 in diabetics)]. ECG changes were measured at a core laboratory and Cornell product (CorP), Sokolow-Lyon product (SokP) and QRS duration (QRSd) criteria were determined. RESULTS: At baseline, 27.4% of patients fulfilled the criteria of LVH by CorP. The proportion of patients with ECG-LVH by CorP criteria decreased to 21.1% at the end of the study, relative risk reduction (RRR) was 22.9%, P<0.001. When using SokP the percentage of ECG-LVH reduced from 24.1 to 21.7% (RRR 9.6%, P=0.1). Quantitatively, CorP was reduced by 84.4 mmxms [95% confidence interval (CI): -8.14, -160.66; P=0.03]; a greater reduction was detected in obese patients (P<0.05), diabetics (P<0.07) and patients with baseline ECG-LVH (P<0.05). In the multivariate analysis, female gender, baseline systolic blood pressure, baseline CorP and QRSd values were the main predictive factors for ECG-LVH regression. CONCLUSION: The SARA study demonstrates that a candesartan-based regimen reduces ECG-LVH in the hypertensive population attending daily in clinical practice.