{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T04:13:23Z","timestamp":1770524003422,"version":"3.49.0"},"reference-count":33,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2014,10,1]],"date-time":"2014-10-01T00:00:00Z","timestamp":1412121600000},"content-version":"vor","delay-in-days":30,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100001502","name":"Blue Cross Blue Shield of Michigan Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100001502","id-type":"DOI","asserted-by":"crossref"}]},{"name":"RWJF Physician Faculty Scholars Program","award":["R01MD005849"],"award-info":[{"award-number":["R01MD005849"]}]},{"name":"Medtronic Steering Committee"},{"name":"Back Beat Hypertension consultancy"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2014,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The objective was to evaluate the diagnostic test characteristics of three validated electrocardiographic (<jats:styled-content style=\"fixed-case\">ECG<\/jats:styled-content>) criteria for the diagnosis of left ventricular hypertrophy (<jats:styled-content style=\"fixed-case\">LVH<\/jats:styled-content>) in undifferentiated, asymptomatic emergency department (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>) patients with hypertension (<jats:styled-content style=\"fixed-case\">HTN<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective cohort study of ED patients with asymptomatic HTN at a single tertiary care facility. Patients 35\u00a0years of age or older with systolic blood pressure (<jats:styled-content style=\"fixed-case\">sBP<\/jats:styled-content>) \u2265 140 mm Hg or diastolic blood pressure (<jats:styled-content style=\"fixed-case\">dBP<\/jats:styled-content>) \u2265 90 mm Hg on two separate readings (at least 1 hour apart) were eligible for inclusion. At enrollment, ECGs were obtained for all patients. Presence of LVH on ECG was defined using Cornell voltage, Cornell product, and Minnesota Code 3.1\/3.2 criteria. Echocardiography was then performed, with LVH defined by the presence of one or more of the following validated criteria: interventricular septal or posterior wall thickness \u2265 1.3 cm, LV mass \u2265 225 g (male) or \u2265 163 g (female), or LV mass indexed to height raised to the power of 2.7 \u2265 48 g\/m<jats:sup>2.7<\/jats:sup> (male) or \u2265 45 g\/m<jats:sup>2.7<\/jats:sup> (female). Descriptive statistics and diagnostic characteristics (i.e., sensitivity and specificity) with corresponding 95% confidence intervals (CIs) for each of the three ECG criteria were derived for both the composite and the individual echocardiographic determinants of LVH. Logistic regression was also used to model LVH before and after subsequent inclusion of clinically relevant variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 161 patients (93.8% African American; mean [\u00b1SD] age\u00a0= 49.8\u00a0[\u00b18.3]\u00a0years) were enrolled, and LVH was present in 89 patients (55.2%, 95% CI\u00a0=\u00a047.6% to 62.8%). On ECG analysis, mean Cornell voltage (21.5 <jats:styled-content style=\"fixed-case\">mV<\/jats:styled-content> vs. 28.7 <jats:styled-content style=\"fixed-case\">mV<\/jats:styled-content>; difference\u00a0= \u20137.2 <jats:styled-content style=\"fixed-case\">mV<\/jats:styled-content>, 95% CI\u00a0= \u20133.8 to \u201310.7\u00a0<jats:styled-content style=\"fixed-case\">mV<\/jats:styled-content>) and Cornell product (1868.4\u00a0msec \u00d7 <jats:styled-content style=\"fixed-case\">mV<\/jats:styled-content> vs. 2616.4 msec \u00d7 <jats:styled-content style=\"fixed-case\">mV<\/jats:styled-content>; difference\u00a0= \u2013748.0 msec \u00d7 <jats:styled-content style=\"fixed-case\">mV<\/jats:styled-content>, 95% CI\u00a0= \u2013401.2 to \u20131094.8 msec \u00d7 <jats:styled-content style=\"fixed-case\">mV<\/jats:styled-content>) were significantly lower among those without LVH on echocardiography. Subjects without LVH on echocardiography were less likely to meet Cornell voltage (30.5% vs. 48.3%; difference\u00a0= \u201317.8%, 95% CI\u00a0= \u20132.5% to \u201331.7%) or Cornell product (26.4% vs. 49.4%; difference\u00a0= \u201323.0%, 95% CI\u00a0= \u20138.0% to \u201336.5%) criteria for LVH. The diagnosis of LVH by Minnesota Code was less common (18.1% vs. 25.8%; difference\u00a0= \u20137.7%, 95% CI\u00a0= \u201320.1% to 5.3%) with no difference by group. Sensitivity and specificity were as follows: for the Cornell voltage, sensitivity 25.4% (95% CI\u00a0=\u00a015.3% to 37.9%), specificity 50.0% (95% CI\u00a0=\u00a067.6% to 93.2%); for the Cornell product, sensitivity 25.4% (95% CI\u00a0=\u00a015.3% to 37.9%), specificity 75.0% (95% CI\u00a0=\u00a019.4% to 99.4%); and for the Minnesota code, sensitivity 26.9% (95% CI\u00a0=\u00a016.6% to 39.7%), specificity 75.0% (95% CI\u00a0=\u00a019.4% to 99.4%). On logistic regression, the c\u2010statistics for Cornell voltage and Cornell product were equivalent (0.67), with only marginal improvement after the addition of body mass index (BMI; 0.69 and 0.70, respectively), B\u2010type natriuretic peptide (BNP; 0.68 and 0.69, respectively), or both (0.71 and 0.72, respectively) to the models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this cohort of predominately African American <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> patients with asymptomatic <jats:styled-content style=\"fixed-case\">HTN<\/jats:styled-content>, sensitivity and specificity of standard <jats:styled-content style=\"fixed-case\">ECG<\/jats:styled-content> criteria were relatively poor for the diagnosis of <jats:styled-content style=\"fixed-case\">LVH<\/jats:styled-content> on echocardiography. Thus, <jats:styled-content style=\"fixed-case\">ECG<\/jats:styled-content> is of limited use for <jats:styled-content style=\"fixed-case\">LVH<\/jats:styled-content> risk stratification in asymptomatic <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> patients with elevated blood pressure, with additional clinical information only modestly strengthening its predictive value.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.12462","type":"journal-article","created":{"date-parts":[[2014,10,1]],"date-time":"2014-10-01T07:59:12Z","timestamp":1412150352000},"page":"996-1002","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Test Characteristics of Electrocardiography for Detection of Left Ventricular Hypertrophy in Asymptomatic Emergency Department Patients With Hypertension"],"prefix":"10.1111","volume":"21","author":[{"given":"James J.","family":"Mahn","sequence":"first","affiliation":[{"name":"The Wayne 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