Open AccessConventional and new electrocardiographic criteria for hypertension‐mediated cardiac organ damage: A narrative review
Author(s) -
Miceli Francesca,
Presta Vivianne,
Citoni Barbara,
Canichella Flaminia,
Figliuzzi Ilaria,
Ferrucci Andrea,
Volpe Massimo,
Tocci Giuliano
Publication year - 2019
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/jch.13726
Subject(s) - medicine , cardiology , left ventricular hypertrophy , heart failure , subclinical infection , asymptomatic , stroke (engine) , myocardial infarction , gold standard (test) , atrial fibrillation , left atrial enlargement , blood pressure , mechanical engineering , sinus rhythm , engineering
Hypertension‐mediated organ damage (HMOD) is frequently observed in hypertensive patients at different cardiovascular (CV) risk profile. This may have both diagnostic and therapeutic implications for the choice of the most appropriate therapies. Among different markers of HMOD, the most frequent functional and structural adaptations can be observed at cardiac level, including left ventricular hypertrophy (LVH), diastolic dysfunction, aortic root dilatation, and left atrial enlargement. In particular, LVH was shown to be a strong and independent risk factor for major CV events, namely myocardial infarction, stroke, congestive heart failure, CV death. Thus, early identification of LVH is a key element for preventing CV events in hypertension. Although echocardiographic assessment of LVH represents the gold standard technique, this is not cost‐effective and cannot be adopted in routine clinical practice of hypertension. On the other hand, electrocardiographic (ECG) assessment of HMOD relative to the heart is a simple, reproducible, widely available and cost‐effective method to assess the presence of LVH, and could be preferred in large scale screening tests. Several new indicators have been proposed and tested in observational studies and clinical trials of hypertension, in order to improve the relatively low sensitivity of the conventional ECG criteria for LVH, despite high specificity. This article reviews the differences in the use of the main conventional and the new 12 lead ECG criteria of LVH for early assessment of asymptomatic, subclinical cardiac HMOD in a setting of clinical practice of hypertension.