This Article  • References  • Full text PDF  • Correction  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (75)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Standard Electrocardiographic Criteria Overestimate Racial Differences in Prevalence

Dara K. Lee, MD; Paul R. Marantz, MD, MPH; Richard B. Devereux, MD; Paul Kligfield, MD; Michael H. Alderman, MD

JAMA. 1992;267(24):3294-3299.

Abstract
Objective.
—To assess racial differences in the accuracy of standard electrocardiographic (ECG) criteria in the diagnosis of left ventricular hypertrophy (LVH).

Design.
—The sensitivity and specificity of standard ECG criteria were compared in blacks and whites using echocardiographic LVH as the reference standard.

Setting.
—Eight worksite-based hypertension clinics in New York, NY.

Patients.
—A sample of 122 black and 148 white hypertensive patients.

Results.
—The prevalence of ECG-LVH was two to six times higher in blacks than in whites, depending on the criteria used (range, 6% to 24% in blacks vs 1% to 7% in whites; P=.0005 to .19 for black-white comparisons). The difference in prevalence of ECG-LVH, however, was less striking and did not attain statistical significance (26% in blacks and 20% in whites; P >.2). The sensitivity of the ECG was low (range, 3% to 17%) and did not differ significantly between the two races for any of the conventional criteria; specificity, however, was lower in blacks for all criteria (range, 73% to 94% vs 95% to 100% for whites; P=.0001 to .09). The predictive value of a positive ECG was consistently, although not significantly, lower in the black subjects. Black race was the strongest independent predictor of decreased ECG specificity in multiple logistic regression analysis that also considered age, gender, body mass index, left ventricular mass index, and smoking.

Conclusions.
—Commonly used ECG criteria for the detection of LVH have a poor sensitivity in both black and white hypertensives and a lower specificity in blacks than in whites; this may lead to a greater number of false-positive diagnoses in black patients, as well as to an overestimation of black-white difference in LVH prevalence.

(JAMA. 1992;267:3294-3299)

Author Affiliations
From the Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY (Drs Lee, Marantz and Alderman), and the Division of Cardiology, Department of Medicine, New York Hospital-Cornell Medical Center, New York, NY (Drs Devereux and Kligfield).

Footnotes
Presented in part at the 31st Annual Conference on Cardiovascular Disease Epidemiology of the American Heart Association, Orlando, Fla, March 14, 1991.

Reprint requests to Department of Epidemiology and Social Medicine, 1300 Morris Park Ave, Room 1301 Belfer ECHS, Bronx, NY 10461 (Dr Marantz).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Ethnicity and Left Ventricular Diastolic Function in Hypertension: An ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) Substudy
Sharp et al.
J Am Coll Cardiol 2008;52:1015-1021.
ABSTRACT | FULL TEXT  

Racial Differences in Prevalence of Coronary Obstructions Among Men With Positive Nuclear Imaging Studies
Whittle et al.
J Am Coll Cardiol 2006;47:2034-2041.
ABSTRACT | FULL TEXT  

Black Pearl in the LIFE Study: Angiotensin-II Receptor Blockade on Atrial Fibrillation for Future Personalized Medicine
Ogimoto et al.
J Am Coll Cardiol 2005;46:1585-1585.
FULL TEXT  

Differences in Left Ventricular Structure Between Black and White Hypertensive Adults: The Hypertension Genetic Epidemiology Network Study
Kizer et al.
Hypertension 2004;43:1182-1188.
ABSTRACT | FULL TEXT  

The Prevalence of Reduced Glomerular Filtration Rate in Older Hypertensive Patients and Its Association With Cardiovascular Disease: A Report From the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial
Rahman et al.
Arch Intern Med 2004;164:969-976.
ABSTRACT | FULL TEXT  

Traditional Risk Factors and the Incidence of Sudden Coronary Death With and Without Coronary Thrombosis in Blacks
Burke et al.
Circulation 2002;105:419-424.
ABSTRACT | FULL TEXT  

HYPERTENSION: Essential hypertension: the heart and hypertension
Berkin and Ball
Heart 2001;86:467-475.
FULL TEXT  

Trends in the Prevalence of Hypertension, Antihypertensive Therapy, and Left Ventricular Hypertrophy from 1950 to 1989
Mosterd et al.
NEJM 1999;340:1221-1227.
ABSTRACT | FULL TEXT  

Differences in Prevalence of and Risk Factors for Subclinical Vascular Disease Among Black and White Participants in the Cardiovascular Health Study
Kuller et al.
Arterioscler. Thromb. Vasc. Bio. 1998;18:283-293.
ABSTRACT | FULL TEXT  

Heritability of Left Ventricular Mass : The Framingham Heart Study
Post et al.
Hypertension 1997;30:1025-1028.
ABSTRACT | FULL TEXT  

Utility of New Electrocardiographic Models for Left Ventricular Mass in Older Adults
Rautaharju et al.
Hypertension 1996;28:8-15.
ABSTRACT | FULL TEXT  

Time-Voltage Area of the QRS for the Identification of Left Ventricular Hypertrophy
Okin et al.
Hypertension 1996;27:251-258.
ABSTRACT | FULL TEXT  

Low Urinary Sodium Is Associated With Greater Risk of Myocardial Infarction Among Treated Hypertensive Men
Alderman et al.
Hypertension 1995;25:1144-1152.
ABSTRACT | FULL TEXT  

The Relative Effects of Left Ventricular Hypertrophy, Coronary Artery Disease, and Ventricular Dysfunction on Survival Among Black Adults
Liao et al.
JAMA 1995;273:1592-1597.
ABSTRACT  

Racial differences in cardiac structure and function in essential hypertension
Mayet et al.
BMJ 1994;308:1011-1014.
ABSTRACT | FULL TEXT  

Treatment of Mild Hypertension: The More Things Change...
Black
JAMA 1993;270:757-759.
ABSTRACT