DIAGNOSTIC UTILITY OF ELECTROCARDIOGRAPHIC CRITERIA FOR IDENTIFYING LEFT VENTRICULAR HYPERTROPHY DEFINED BY ECHOCARDIOGRAPHY IN ADULTS WITH UNCOMPLICATED HYPERTENSION IN AFRICA

Objective: Traditional electrocardiographic (ECG) criteria for detecting left ventricular (LV) hypertrophy (LVH) have mainly been established and evaluated in populations with underrepresentation of persons with African descent. We tested the suitability of these LVH ECG criteria in a large population of black African adults with untreated, uncomplicated hypertension in comparison to LV mass at echocardiography. Design and method: Within the CoArtHA (Identifying most effective Treatment Strategies to control Arterial Hypertension in sub-Saharan Africa, NCT04129840) trial, which included 1268 treatment-naïve adults with clinically uncomplicated hypertension in rural Tanzania and Lesotho. We analysed the value of 11 traditional ECG criteria in comparison to cardiac geometry assessed by echocardiography at baseline. Echocardiographic LVH was defined as Left Ventricular Mass Indexed to Body Surface Area (LVMI) >95 g/m2in women, >115 g/m2in men. Correlations in continuous data were calculated using the Spearman method. Discriminative performance of variables was calculated as area under the curve (AUC). Results: Baseline ECG and echocardiographic data were available in 1125 participants (median age 53.4 (45.6 – 64.4) years, 72% women). The median (IQR) systolic/diastolic clinic blood pressure was 149 (141 – 163) /99 (93 – 106) mmHg. Echocardiographic LVH was found in 56 (5%) participants. The best correlations with LVMI were observed for Cornell Voltage Product, Cornell Voltage Criteria, and R amplitude in aVL (r = 0.373, r = 0.327, and r = 0.304, respectively; p < 0.001 for all), with all others r < 0.3. Highest specificity was found for strain pattern, Cornell voltage product and R amplitude in aVL (0.970, 0.923, and 0.844, respectively). Highest positive predictive value was found for strain pattern, Cornell voltage product and Sokolow-Lyon voltage product (0.272, 0.204, and 0.140, respectively). Best discriminative performance was found for Cornell Voltage Product, R amplitude in aVL, and Cornell Voltage Criteria (AUC values 0.738, 0.708, and 0.704, respectively, Figure).Conclusions: The results of this analysis demonstrated that overall, the Cornell Voltage Product may have the highest diagnostic accuracy in this selected population with the limitation of a weak to moderate correlation and at best acceptable discriminative property.