RELATION BETWEEN ELECTROCARDIOGRAPHY AND ECHOCARDIOGRAPHY FOR LEFT-VENTRICULAR MASS IN MILD SYSTEMIC HYPERTENSION (RESULTS TRAM TREATMENT AT MILD HYPERTENSION STUDY)

Clinical recognition of hypertensive cardiac involvement depends prima rily on use of noninvasive methods. The performance of 8 (ECG) criteri a sets were compared with an standard in the Treatment of Mild Hyperte nsion Study. Electrocardiograms were computer processed to define the following ECG criteria sets: (1) Casale/Devereux, (2) Cornell product, (3) Cornell voltage, (4) 12-lead voltage product, (5) sum of 12-lead voltage, (6) Rautaharju, (7) Sokolow-Lyon, and (8) Romhilt-Estes. Echo cardiographic left ventricular (LV) mass index was calculated using th e Penn convention on a biracial population 834 men and women. Correlat ions between ECG and echocardiographic LV mass index were modest (<0.4 0). ECG-LV hypertrophy sensitivity at 95% specificity was <34%. The Ca sale/Deverevx ECG criteria showed the highest average sensitivity (17% ) at 95% specificity far all race-sex groups. Whites had significantly higher correlation values than blacks. ECG correlations with LV mass index were consistently improved by including systolic blood pressure and body mass index. ECG criteria sets appear to be optimized for whit e men. The study findings confirm the poor ECG sensitivity and correla tion with echocardiographic LV mass and suggest: (1) further refinemen t of ECG criteria alone in white men is unlikely to improve its relati onship with LV mass; and (2) combining the electrocardiogram with othe r non-ECG variables or noninvasive measurements offers the best strate gy for improving ECG sensitivity and its prognostic valve.