Open AccessLow QRS Voltage in Limb Leads Indicates Accompanying Precordial Voltage Attenuation Resulting in Underestimation of Left Ventricular Hypertrophy
Author(s) -
Hye-bin Gwag,
Suhyun Lee,
Hyeon-Jun Kim,
June-Soo Kim,
YoungKeun On,
SeungJung Park,
KyoungMin Park
Publication year - 2021
Publication title -
international journal of environmental research and public health/international journal of environmental research and public health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.747
H-Index - 113
eISSN - 1661-7827
pISSN - 1660-4601
DOI - 10.3390/ijerph182412867
Subject(s) - medicine , cardiology , left ventricular hypertrophy , qrs complex , etiology , electrocardiography , precordial examination , population , heart disease , blood pressure , environmental health
Low QRS voltage (LQRSV) in electrocardiography (ECG) often occurs in limb leads without apparent cause. However, its clinical significance is obscure in healthy populations. We reviewed patients aged over 60 who were scheduled for non-cardiac surgery in two hospitals. Patients underwent pre-operative ECG, echocardiography, pulmonary function test, and chest X-ray. Patients with LQRSV isolated to limb leads and patients without LQRSV were selected from separate hospitals. Among the 9832 patients screened in one hospital, 292 (3.0%) showed LQRSV in limb leads. One-hundred and ninety-four without LQRSV were selected as the control from the 216 patients screened at the other hospital. For primary analysis, patients with structural heart disease or classic etiologies of LQRSV were excluded. Patients with LQRSV had a higher proportion of male and a greater body mass index. Precordial QRS voltages were smaller, whereas left ventricular mass index and the prevalence of echocardiographic left ventricular hypertrophy (LVH) was higher in patients with LQRSV than in those without. Consequentially, diagnostic performance of precordial voltage criteria for LVH was particularly poor in patients with LQRSV in limb leads. LQRSV in limb leads frequently occurs without apparent etiologies. ECG voltage criteria may underestimate LVH in a relatively healthy population with LQRSV in limb leads.