Left ventricular mass in hypertension – correlative study of electrocardiography and echocardiography

Background: Left ventricular hypertrophy {LVH} has been repeatedly shown to be associated with a marked increase in cardiovascular risk. The ECG evidence of LVH is present only in 50% of patients with anatomic LVH. ECG may be entirely normal in around 15% patients with severe LVH. Echocardiography can show LVH in almost 100% of patients. Obective: The purpose of this study is to determine the sensitivity of ECG in diagnosis of left ventricular hypertrophy by its correlation with echocardiography studies of left ventricular mass in hypertensive patients. Materials and Methods: The study was carried out on 130 patients attending the hospital with systemic hypertension diagnosed by JNC VII criteria and managed at B.L.D.E A’s Shri B.M Patil Medical College and Hospital. 12 lead ECG and Echo cardiograph examination for assessment of left ventricular function and mass was done using M mode and 2D echocardiography. Left ventricular mass was calculated in each case using the Devereux Formula. LV Mass=1.04 [{IVS (d)+ LVID (D)+ LVPWT (d)}3]- [LVID (d)]3- 13.6gms where 1.04 is the specific gravity of cardiac muscle. Comparison was done with a control group of 100 patients. The correlation of ECG data and echocardiograph findings in relation to LV mass was carried out is each case. Observations: In all the patients in study group ECG evidence of LVH was calculated by Sokolow-Lyon criteria and Romhilt-Estes scoring systems. LVH by Sokolow-Lyon criteria was present in 29 patients (22.31%), and LVH was absent in 101 patients (77.69%), but echocardiograph showed LVH in all 130 patients. Observed LVH by Rhomhilt-Estes scorings system was present in 38 patients (29.23%) and absent in 92 patients (70.77%). But echo cardiograph showed LVH in all 130 patients. The mean left ventricular mass calculated was 179.07+36.62gms in males and 103.78+15.84gms in females in study group. Control group had 112.84+ 5.88gms in males and 73.36+ 9.41gms in females. There was significant increase in the left ventricular mass in study group when compared to control group. The sensitivity of Sokolow-Lyon was 22.30% and the sensitivity of Romhilt Estes point scoring system was 29.23%. Sensitivity of echo in detecting LVH in hypertensive patients was 100%. Conclusion: It is concluded in our study that echocardiography is highly reliable and sensitive compared to electrocardiogram in the assessment of LVH in these patients.