Despite the low sensitivity of the electrocardiogram (ECG) in detecting left ventricular
hypertrophy (LVH), ECG-LVH is known to be a strong predictor of cardiovascular risk.
Understanding reasons for the discrepancies in detection of LVH by ECG versus imaging
could help improve the diagnostic ability of ECG. We examined factors associated with
false-positive and false-negative ECG-LVH, using cardiac magnetic resonance imaging
(MRI) as the gold standard. We also compared the prognostic significance of ECG-LVH
and MRI-LVH as predictors of cardiovascular events. This analysis included 4,748 participants
(mean age 61.9 years, 53.5% females, 61.7% nonwhites). Logistic regression with stepwise
selection was used to identify factors associated with false-positive (n = 208) and
false-negative (n = 387), compared with true-positive (n = 208) and true-negative
(n = 4,041) ECG-LVH, respectively. A false-negative ECG-LVH status was associated
with increased odds of Hispanic race/ethnicity, current smoking, hypertension, increased
systolic blood pressure, prolongation of QRS duration, and higher body mass index
and with lower odds of increased ejection fraction (model-generalized R2 = 0.20). A false-positive ECG-LVH status was associated with lower odds of black
race, Hispanic race/ethnicity, minor ST-T abnormalities, increased systolic blood
pressure, and presence of any major electrocardiographic abnormalities (model-generalized
R2 = 0.29). Both ECG-LVH and MRI-LVH were associated with an increased risk of cardiovascular
disease events (hazard ratio 1.51, 95% confidence interval 1.03 to 2.20 and hazard
ratio 1.81, 95% confidence interval 1.33 to 2.46, respectively). In conclusion, discrepancy
in LVH detection by ECG and MRI can be relatively improved by considering certain
participant characteristics. Discrepancy in diagnostic performance, yet agreement
on predictive ability, suggests that LVH by ECG and LVH by imaging are likely to be
two distinct but somehow related phenotypes.
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Article info
Publication history
Published online: November 29, 2014
Accepted:
November 12,
2014
Received in revised form:
November 12,
2014
Received:
October 22,
2014
Footnotes
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© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
