ECG-based detection of left ventricle hypertrophy
Zago, Gabriel Tozatto; Andreão, Rodrigo Varejão; Rodrigues, Sérgio Lamego; Mill, José Geraldo; Sarcinelli Filho, Mário
http://dx.doi.org/10.1590/2446-4740.0691
Res. Biomed. Eng., vol.31, n2, p.125-132, 2015
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Abstract
Introduction: Left ventricle hypertrophy (LVH) is an important risk factor for cardiovascular morbidity and mortality. It is characterized by a thickening of the walls of the left ventricle. The transthoracic echocardiogram is a very accurate method for LVH detection. However, the electrocardiogram (ECG) offers an alternative method in diagnosing LVH, besides being less expensive and easier to obtain. In this context, this study proposes an ECG based approach for left ventricle hypertrophy (LVH) classification. Methods: According to the literature, several indexes have so far been proposed that suggest specific changes in cardiac structure, however, generally speaking there is no consensus about the best criteria. This way, instead of considering only one LVH criterion, a score derived from electrocardiographic traces was employed which explores the complementarity of the best criteria through a fusion strategy. The best criteria are those which discriminate normal and LVH ECGs. Results: The experiments were performed in the Monica database with a group of fifty men. Half of the individuals had LVH diagnosed by calculating the left ventricular mass index measured by transthoracic echocardiography. The score fusion proposed achieved a sensitivity of 78.3% and specificity of 91.3%, outperforming all isolated LVH criteria. Discussion: Unlike the other methods, our score must be estimated within a computer because of its high complexity. Even with this limitation it is much less expensive than using the echocardiography.
Keywords
Left ventricle hypertrophy, Electrocardiogram, Score fusion.
References
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Casale PN, Devereux RB, Kligfield P, Eisenberg RR, Miller DH, Chaudhary BS, Phillips MC. Electrocardiographic detection of left ventricular hypertrophy: development and prospective validation of improved criteria. Journal of the American College of Cardiology. 1985; 6(3):572-80. http://dx.doi.org/10.1016/S0735-1097(85)80115-7. PMid:3161926
De Simone G, Kizer JR, Chinali M, Roman MJ, Bella JN, Best LG, Lee ET, Devereux RB, Strong Heart Study Investigators. Normalization for body size and population-attributable risk of left ventricular hypertrophy: the Strong Heart Study. American Journal of Hypertension. 2005; 18(2 Pt 1):191-6. http://dx.doi.org/10.1016/j.amjhyper.2004.08.032. PMid:15752946
Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. The American Journal of Cardiology. 1986; 57(6):450-8. http://dx.doi.org/10.1016/0002-9149(86)90771-X. PMid:2936235
Fawcett T. An introduction to ROC analysis. Pattern Recognition Letters. 2006; 27(8):861-74. http://dx.doi.org/10.1016/j.patrec.2005.10.010
Ganau A, Devereux RB, Roman MJ, Simone G, Pickering TG, Saba PS, Vargiu P, Simongini I, Laragh JH. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. Journal of the American College of Cardiology. 1992; 19(7):1550-8. http://dx.doi.org/10.1016/0735-1097(92)90617-V. PMid:1534335
Grant RP. Clinical electrocardiography: the spatial vector approach. New York: McGraw-Hill Book Company; 1957
Gubner R, Ungerleider HE. Electrocardiographic criteria of left ventricular hypertrophy. Archives of Internal Medicine. 1943; 72(2):196-209. http://dx.doi.org/10.1001/archinte.1943.00210080052005
Haider AW, Larson MG, Benjamin EJ, Levy D. Increased left ventricular mass and hypertrophy are associated with increased risk for sudden death. Journal of the American College of Cardiology. 1998; 32(5):1454-9. http://dx.doi.org/10.1016/S0735-1097(98)00407-0. PMid:9809962
Hamilton P. Open source ECG analysis. Computers in Cardiology. 2002; 29:101-4
Hancock EW, Deal BJ, Mirvis DM, Okin P, Kligfield P, Gettes LS, Bailey JJ, Childers R, Gorgels A, Josephson M, Kors JA, Macfarlane P, Mason JW, Pahlm O, Rautaharju PM, Surawicz B, van Herpen G, Wagner GS, Wellens H, American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology, American College of Cardiology Foundation, Heart Rhythm Society, Endorsed by the International Society for Computerized Electrocardiology. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Journal of the American College of Cardiology. 2009; 53(11):992-1002. http://dx.doi.org/10.1016/j.jacc.2008.12.015. PMid:19281932
Kreger BE, Cupples LA, Kannel WB. The electrocardiogram in prediction of sudden death: framingham study experience. American Heart Journal. 1987; 113(2 Pt 1):377-82. http://dx.doi.org/10.1016/0002-8703(87)90281-X
Lewis T. Observations upon ventricular hypertrophy with especial reference preponderance of one or other chamber. Heart. 1914; 5:367-403
Martínez JP, Almeida R, Olmos S, Rocha AP, Laguna P. A wavelet-based ECG delineator: evaluation on standard databases. IEEE Transactions on Biomedical Engineering. 2004; 51(4):570-81. http://dx.doi.org/10.1109/TBME.2003.821031. PMid:15072211
Mazzaro CDL, Costa FDA, Bombig MTN, Luna B Fo, Paola ÂAV, Carvalho ACDC, Costa W, Fonseca FAH, Póvoa RMDS. Ventricular mass and electrocardiographic criteria of hypertrophy: evaluation of new score. Arquivos Brasileiros de Cardiologia. 2008; 90(4):227-31, 249-253
McPHIE J. Left ventricular hypertrophy: electrocardiographic diagnosis. Australasian Annals of Medicine. 1958; 7(4):317-27. PMid:13607332
Molloy TJ, Okin PM, Devereux RB, Kligfield P. Electrocardiographic detection of left ventricular hypertrophy by the simple QRS voltage-duration product. Journal of the American College of Cardiology. 1992; 20(5):1180-6. http://dx.doi.org/10.1016/0735-1097(92)90376-X. PMid:1401620
Murphy ML, Thenabadu PN, Soyza N, Doherty JE, Meade J, Baker BJ, Whittle JL. Reevaluation of electrocardiographic criteria for left, right and combined cardiac ventricular hypertrophy. The American Journal of Cardiology. 1984; 53(8):1140-7. http://dx.doi.org/10.1016/0002-9149(84)90651-9. PMid:6230928
Roman MJ, Kligfield P, Devereux RB, Niles NW, Hochreiter C, Halle A, Sato N, Borer JS. Geometric and functional correlates of electrocardiographic repolarization and voltage abnormalities in aortic regurgitation. Journal of the American College of Cardiology. 1987; 9(3):500-8. http://dx.doi.org/10.1016/S0735-1097(87)80041-4. PMid:3819197
4231231"Romhilt DW, Estes EH Jr. A point-score system for the ECG diagnosis of left ventricular hypertrophy. American Heart Journal. 1968; 75(6):752-8. http://dx.doi.org/10.1016/0002-8703(68)90035-5. PMid:4231231
4240354"Romhilt DW, Bove KE, Norris RJ, Conyers E, Conradi S, Rowlands DT, Scott RC. A critical appraisal of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy. Circulation. 1969; 40(2):185-96. http://dx.doi.org/10.1161/01.CIR.40.2.185. PMid:4240354
Siegel RJ, Roberts WC. Electrocardiographic observations in severe aortic valve stenosis: correlative necropsy study to clinical, hemodynamic, and ECG variables demonstrating relation of 12-lead QRS amplitude to peak systolic transaortic pressure gradient. American Heart Journal. 1982; 103(2):210-21. http://dx.doi.org/10.1016/0002-8703(82)90494-X. PMid:6459734
Sokolow M, Lyon TP. The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. American Heart Journal. 1949; 37(2):161-86. http://dx.doi.org/10.1016/0002-8703(49)90562-1. PMid:18107386
Sousa AGP, Pereira AC, Marquezine GF, Nascimento-Neto RM, Freitas SN, Nicolato RLC, Machado-Coelho GL, Rodrigues SL, Mill JG, Krieger JE. Derivation and external validation of a simple prediction model for the diagnosis of type 2 diabetes mellitus in the Brazilian urban population. European Journal of Epidemiology. 2009; 24(2):101-9. http://dx.doi.org/10.1007/s10654-009-9314-2. PMid:19190989
Wilson FN, Johnston FD, Rosenbaum FF, Erlanger H, Kossmann CE, Hecht H, Cotrim N, Oliveira RM, Scarsi R, Barker PS. The precordial electrocardiogram. American Heart Journal. 1944; 27(1):19-85. http://dx.doi.org/10.1016/S0002-8703(44)90603-4. PMid:20996759
Wolff MDL. Electrocardiography: fundamentals and clinical applications. St. Louis: W.B. Saunders; 1962
Zhang Q, Manriquez AI, Médigue C, Papelier Y, Sorine M. An algorithm for robust and efficient location of T-wave ends in electrocardiograms. IEEE Transactions on Biomedical Engineering. 2006; 53(12 Pt 1):2544-52. http://dx.doi.org/10.1109/TBME.2006.884644. PMid:17153212
Zhou SH, Helfenbein ED, Lindauer JM, Gregg RE, Feild DQ. Philips QT interval measurement algorithms for diagnostic, ambulatory, and patient monitoring ECG applications. Annals of Noninvasive Electrocardiology. 2009; 14(Suppl 1):S3-8. http://dx.doi.org/10.1111/j.1542-474X.2008.00258.x. PMid:19143739
Zhou X, Wei D. A multidifferentiator-based approach to the reliable determination of T-wave offset in electrocardiograms. Journal of Electrocardiology. 2011; 44(3):330-9. http://dx.doi.org/10.1016/j.jelectrocard.2010.11.003. PMid:21276591
Casale PN, Devereux RB, Kligfield P, Eisenberg RR, Miller DH, Chaudhary BS, Phillips MC. Electrocardiographic detection of left ventricular hypertrophy: development and prospective validation of improved criteria. Journal of the American College of Cardiology. 1985; 6(3):572-80. http://dx.doi.org/10.1016/S0735-1097(85)80115-7. PMid:3161926
De Simone G, Kizer JR, Chinali M, Roman MJ, Bella JN, Best LG, Lee ET, Devereux RB, Strong Heart Study Investigators. Normalization for body size and population-attributable risk of left ventricular hypertrophy: the Strong Heart Study. American Journal of Hypertension. 2005; 18(2 Pt 1):191-6. http://dx.doi.org/10.1016/j.amjhyper.2004.08.032. PMid:15752946
Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. The American Journal of Cardiology. 1986; 57(6):450-8. http://dx.doi.org/10.1016/0002-9149(86)90771-X. PMid:2936235
Fawcett T. An introduction to ROC analysis. Pattern Recognition Letters. 2006; 27(8):861-74. http://dx.doi.org/10.1016/j.patrec.2005.10.010
Ganau A, Devereux RB, Roman MJ, Simone G, Pickering TG, Saba PS, Vargiu P, Simongini I, Laragh JH. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. Journal of the American College of Cardiology. 1992; 19(7):1550-8. http://dx.doi.org/10.1016/0735-1097(92)90617-V. PMid:1534335
Grant RP. Clinical electrocardiography: the spatial vector approach. New York: McGraw-Hill Book Company; 1957
Gubner R, Ungerleider HE. Electrocardiographic criteria of left ventricular hypertrophy. Archives of Internal Medicine. 1943; 72(2):196-209. http://dx.doi.org/10.1001/archinte.1943.00210080052005
Haider AW, Larson MG, Benjamin EJ, Levy D. Increased left ventricular mass and hypertrophy are associated with increased risk for sudden death. Journal of the American College of Cardiology. 1998; 32(5):1454-9. http://dx.doi.org/10.1016/S0735-1097(98)00407-0. PMid:9809962
Hamilton P. Open source ECG analysis. Computers in Cardiology. 2002; 29:101-4
Hancock EW, Deal BJ, Mirvis DM, Okin P, Kligfield P, Gettes LS, Bailey JJ, Childers R, Gorgels A, Josephson M, Kors JA, Macfarlane P, Mason JW, Pahlm O, Rautaharju PM, Surawicz B, van Herpen G, Wagner GS, Wellens H, American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology, American College of Cardiology Foundation, Heart Rhythm Society, Endorsed by the International Society for Computerized Electrocardiology. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Journal of the American College of Cardiology. 2009; 53(11):992-1002. http://dx.doi.org/10.1016/j.jacc.2008.12.015. PMid:19281932
Kreger BE, Cupples LA, Kannel WB. The electrocardiogram in prediction of sudden death: framingham study experience. American Heart Journal. 1987; 113(2 Pt 1):377-82. http://dx.doi.org/10.1016/0002-8703(87)90281-X
Lewis T. Observations upon ventricular hypertrophy with especial reference preponderance of one or other chamber. Heart. 1914; 5:367-403
Martínez JP, Almeida R, Olmos S, Rocha AP, Laguna P. A wavelet-based ECG delineator: evaluation on standard databases. IEEE Transactions on Biomedical Engineering. 2004; 51(4):570-81. http://dx.doi.org/10.1109/TBME.2003.821031. PMid:15072211
Mazzaro CDL, Costa FDA, Bombig MTN, Luna B Fo, Paola ÂAV, Carvalho ACDC, Costa W, Fonseca FAH, Póvoa RMDS. Ventricular mass and electrocardiographic criteria of hypertrophy: evaluation of new score. Arquivos Brasileiros de Cardiologia. 2008; 90(4):227-31, 249-253
McPHIE J. Left ventricular hypertrophy: electrocardiographic diagnosis. Australasian Annals of Medicine. 1958; 7(4):317-27. PMid:13607332
Molloy TJ, Okin PM, Devereux RB, Kligfield P. Electrocardiographic detection of left ventricular hypertrophy by the simple QRS voltage-duration product. Journal of the American College of Cardiology. 1992; 20(5):1180-6. http://dx.doi.org/10.1016/0735-1097(92)90376-X. PMid:1401620
Murphy ML, Thenabadu PN, Soyza N, Doherty JE, Meade J, Baker BJ, Whittle JL. Reevaluation of electrocardiographic criteria for left, right and combined cardiac ventricular hypertrophy. The American Journal of Cardiology. 1984; 53(8):1140-7. http://dx.doi.org/10.1016/0002-9149(84)90651-9. PMid:6230928
Roman MJ, Kligfield P, Devereux RB, Niles NW, Hochreiter C, Halle A, Sato N, Borer JS. Geometric and functional correlates of electrocardiographic repolarization and voltage abnormalities in aortic regurgitation. Journal of the American College of Cardiology. 1987; 9(3):500-8. http://dx.doi.org/10.1016/S0735-1097(87)80041-4. PMid:3819197
4231231"Romhilt DW, Estes EH Jr. A point-score system for the ECG diagnosis of left ventricular hypertrophy. American Heart Journal. 1968; 75(6):752-8. http://dx.doi.org/10.1016/0002-8703(68)90035-5. PMid:4231231
4240354"Romhilt DW, Bove KE, Norris RJ, Conyers E, Conradi S, Rowlands DT, Scott RC. A critical appraisal of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy. Circulation. 1969; 40(2):185-96. http://dx.doi.org/10.1161/01.CIR.40.2.185. PMid:4240354
Siegel RJ, Roberts WC. Electrocardiographic observations in severe aortic valve stenosis: correlative necropsy study to clinical, hemodynamic, and ECG variables demonstrating relation of 12-lead QRS amplitude to peak systolic transaortic pressure gradient. American Heart Journal. 1982; 103(2):210-21. http://dx.doi.org/10.1016/0002-8703(82)90494-X. PMid:6459734
Sokolow M, Lyon TP. The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. American Heart Journal. 1949; 37(2):161-86. http://dx.doi.org/10.1016/0002-8703(49)90562-1. PMid:18107386
Sousa AGP, Pereira AC, Marquezine GF, Nascimento-Neto RM, Freitas SN, Nicolato RLC, Machado-Coelho GL, Rodrigues SL, Mill JG, Krieger JE. Derivation and external validation of a simple prediction model for the diagnosis of type 2 diabetes mellitus in the Brazilian urban population. European Journal of Epidemiology. 2009; 24(2):101-9. http://dx.doi.org/10.1007/s10654-009-9314-2. PMid:19190989
Wilson FN, Johnston FD, Rosenbaum FF, Erlanger H, Kossmann CE, Hecht H, Cotrim N, Oliveira RM, Scarsi R, Barker PS. The precordial electrocardiogram. American Heart Journal. 1944; 27(1):19-85. http://dx.doi.org/10.1016/S0002-8703(44)90603-4. PMid:20996759
Wolff MDL. Electrocardiography: fundamentals and clinical applications. St. Louis: W.B. Saunders; 1962
Zhang Q, Manriquez AI, Médigue C, Papelier Y, Sorine M. An algorithm for robust and efficient location of T-wave ends in electrocardiograms. IEEE Transactions on Biomedical Engineering. 2006; 53(12 Pt 1):2544-52. http://dx.doi.org/10.1109/TBME.2006.884644. PMid:17153212
Zhou SH, Helfenbein ED, Lindauer JM, Gregg RE, Feild DQ. Philips QT interval measurement algorithms for diagnostic, ambulatory, and patient monitoring ECG applications. Annals of Noninvasive Electrocardiology. 2009; 14(Suppl 1):S3-8. http://dx.doi.org/10.1111/j.1542-474X.2008.00258.x. PMid:19143739
Zhou X, Wei D. A multidifferentiator-based approach to the reliable determination of T-wave offset in electrocardiograms. Journal of Electrocardiology. 2011; 44(3):330-9. http://dx.doi.org/10.1016/j.jelectrocard.2010.11.003. PMid:21276591
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