Left ventricular hypertrophy is 1 of the most frequent cardiac manifestations associated
with an unfavorable prognosis. However, many different causes of left ventricular
hypertrophy exist. The aim of the present study was to assess the diagnostic value
of common electrocardiographic (ECG) parameters to differentiate Fabry disease (FD),
amyloidosis, and nonobstructive hypertrophic cardiomyopathy (HC) from hypertensive
heart disease (HHD) and aortic stenosis (AS). In 94 patients with newly diagnosed
FD (n = 17), HHD (n = 20), amyloidosis (n = 17), AS (n = 20), and HC (n = 20), common
ECG parameters were analyzed and tested for their diagnostic value. A stepwise approach
including the Sokolow–Lyon index, corrected QT duration, and PQ interval minus P-wave
duration in lead II to overcome P-wave abnormalities was applied. A corrected QT duration
<440 ms in combination with a PQ interval minus P-wave duration in lead II <40 ms
was 100% sensitive and 99% specific for the diagnosis of FD, whereas a corrected QT
duration >440 ms and a Sokolow–Lyon index ≤1.5 mV were found to have a sensitivity
and specificity of 85% and 100%, respectively, for the diagnosis of amyloidosis and
differentiation from HC, AS, and HHD. Moreover, a novel index ([PQ interval minus
P-wave duration in lead II multiplied by corrected QT duration]/Sokolow–Lyon index)
proved to be highly diagnostic for the differentiation of amyloidosis (area under
the curve 0.92) and FD (area under the curve 0.91) by receiver operator characteristic
analysis. In conclusion, a combined analysis of PQ interval minus P-wave duration
in lead II, corrected QT duration, and Sokolow–Lyon index proved highly sensitive
and specific in the differentiation of FD, amyloidosis, and HC compared to HHD and
AS. Analysis of these easy-to-assess ECG parameters may be of substantial help in
the diagnostic workup of these 5 conditions.
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Article info
Publication history
Published online: November 21, 2011
Accepted:
September 29,
2011
Received in revised form:
September 29,
2011
Received:
August 21,
2011
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
