Ethnic differences in the identification of left ventricular hypertrophy in the hypertensive patient

被引:54
作者
Chapman, JN
Mayet, J
Chang, CL
Foale, RA
Thom, SAM
Poulter, NR
机构
[1] St Marys Hosp, Imperial Coll, Sch Med, Dept Clin Pharmacol, London W2 1NY, England
[2] St Marys Hosp, Imperial Coll, Sch Med, Dept Cardiol, London W2 1NY, England
[3] St Marys Hosp, Peart Rose Clin, London W2 1NY, England
关键词
left ventricular hypertrophy; hypertension; electrocardiography; ethnicity; echocardiography;
D O I
10.1016/S0895-7061(99)00027-8
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
Left ventricular hypertrophy (LVH) is more prevalent in black than white hypertensives, but this difference is greater when identified by electrocardiography (ECG) than by echocardiography. We evaluated the proposal that current ECG criteria for LVH are less specific, and therefore, less useful, in blacks than whites. In a retrospective cross-sectional study, 408 subjects (271 white, 137 black) referred to a hypertension clinic for assessment of hypertension underwent measurement of blood pressure, ECG voltages (Sokolow-Lyon and Cornell sex-specific), and echocardiographic left ventricular mass index (LVMI). Black subjects had greater ECG voltages than whites, even when closely matched for LVMI. In black subjects, current ECG criteria were twice as sensitive as in whites (Sokolow-Lyon: 44.9% v 22.5%, P = .003, Cornell: 30.4% v 15.7%, P = .03). They were less specific in blacks using the Sokolow-Lyon criteria (73.5% v 86.8%, P = .02) but this failed to reach significance using the Cornell criteria (83.8% v 91.8%, P = .07). When voltage criteria were adjusted to give matched sensitivities and specificities, respectively, differences in specificity and sensitivity were no longer apparent. Receiver operating characteristic curve analyses confirmed no significant differences in overall performance of either ECG criteria between blacks and whites. In conclusion, ECG detection of LVH is insensitive in both ethnic groups. Sensitivity is higher in blacks due to higher LVMI in those with LVH. Apparent differences in specificity are due to ethnic differences in ECG voltages that are unrelated to differences in LVMI. When these differences are taken into account, there are no overall differences in test accuracy. However, given the prognostic importance of the detection of LVH, currently accepted ECG voltage criteria for the detection of LVH remain of equal or greater value in black hypertensives compared with whites. (C) 1999 American Journal of Hypertension, Ltd.
引用
收藏
页码:437 / 442
页数:6
相关论文
共 26 条
[1]  
ARNETT D K, 1992, Ethnicity and Disease, V2, P10
[2]   CARDIOTHORACIC RATIOS IN 2 JAMAICAN COMMUNITIES [J].
ASHCROFT, MT ;
MIALL, WE .
AMERICAN JOURNAL OF EPIDEMIOLOGY, 1969, 89 (02) :161-&
[3]   EPIDEMIOLOGICAL STUDY OF LEFT-VENTRICULAR HYPERTROPHY IN BIRACIAL POPULATION OF EVANS COUNTY, GEORGIA [J].
BEAGLEHOLE, R ;
TYROLER, HA ;
CASSEL, JC ;
DEUBNER, DC ;
BARTEL, AG ;
HAMES, CG .
JOURNAL OF CHRONIC DISEASES, 1975, 28 (10) :549-559
[4]   IMPROVED SEX-SPECIFIC CRITERIA OF LEFT-VENTRICULAR HYPERTROPHY FOR CLINICAL AND COMPUTER INTERPRETATION OF ELECTROCARDIOGRAMS - VALIDATION WITH AUTOPSY FINDINGS [J].
CASALE, PN ;
DEVEREUX, RB ;
ALONSO, DR ;
CAMPO, E ;
KLIGFIELD, P .
CIRCULATION, 1987, 75 (03) :565-572
[5]   ELECTROCARDIOGRAPHIC DETECTION OF LEFT-VENTRICULAR HYPERTROPHY - DEVELOPMENT AND PROSPECTIVE VALIDATION OF IMPROVED CRITERIA [J].
CASALE, PN ;
DEVEREUX, RB ;
KLIGFIELD, P ;
EISENBERG, RR ;
MILLER, DH ;
CHAUDHARY, BS ;
PHILLIPS, MC .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1985, 6 (03) :572-580
[6]   VALUE OF ECHOCARDIOGRAPHIC MEASUREMENT OF LEFT-VENTRICULAR MASS IN PREDICTING CARDIOVASCULAR MORBID EVENTS IN HYPERTENSIVE MEN [J].
CASALE, PN ;
DEVEREUX, RB ;
MILNER, M ;
ZULLO, G ;
HARSHFIELD, GA ;
PICKERING, TG ;
LARAGH, JH .
ANNALS OF INTERNAL MEDICINE, 1986, 105 (02) :173-178
[7]   ECHOCARDIOGRAPHIC MEASURES OF LEFT-VENTRICULAR STRUCTURE AND THEIR RELATION WITH REST AND AMBULATORY BLOOD-PRESSURE IN BLACKS AND WHITES IN THE UNITED-KINGDOM [J].
CHATURVEDI, N ;
ATHANASSOPOULOS, G ;
MCKEIGUE, PM ;
MARMOT, MG ;
NIHOYANNOPOULOS, P .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1994, 24 (06) :1499-1505
[8]   RELATION BETWEEN ELECTROCARDIOGRAPHY AND ECHOCARDIOGRAPHY FOR LEFT-VENTRICULAR MASS IN MILD SYSTEMIC HYPERTENSION (RESULTS TRAM TREATMENT AT MILD HYPERTENSION STUDY) [J].
CROW, RS ;
PRINEAS, RJ ;
RAUTAHARJU, P ;
HANNAN, P ;
LIEBSON, PR .
AMERICAN JOURNAL OF CARDIOLOGY, 1995, 75 (17) :1233-1238
[9]   ELECTROCARDIOGRAPHIC DETECTION OF LEFT-VENTRICULAR HYPERTROPHY USING ECHOCARDIOGRAPHIC DETERMINATION OF LEFT-VENTRICULAR MASS AS THE REFERENCE-STANDARD - COMPARISON OF STANDARD CRITERIA, COMPUTER-DIAGNOSIS AND PHYSICIAN INTERPRETATION [J].
DEVEREUX, RB ;
CASALE, PN ;
EISENBERG, RR ;
MILLER, DH ;
KLIGFIELD, P .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1984, 3 (01) :82-87
[10]   ECHOCARDIOGRAPHIC DETERMINATION OF LEFT-VENTRICULAR MASS IN MAN - ANATOMIC VALIDATION OF METHOD [J].
DEVEREUX, RB ;
REICHEK, N .
CIRCULATION, 1977, 55 (04) :613-618