{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T13:03:50Z","timestamp":1784639030498,"version":"3.55.0"},"reference-count":64,"publisher":"Ubiquity Press, Ltd.","issue":"1","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["gh"],"abstract":"<jats:p>Background: Electrocardiographic (ECG) criteria for detecting left ventricular hypertrophy (LVH) have largely been derived from non-African populations. Their diagnostic performance in Black African adults with untreated hypertension remains uncertain.\nObjective: To evaluate the diagnostic performance of established ECG-LVH criteria compared with echocardiographically assessed left ventricular mass index (LVMI) in Black African adults with untreated, uncomplicated hypertension enrolled in the coArtHA trial.\nMethods: In this subanalysis, we included 1,125 participants from rural Tanzania and Lesotho who underwent baseline 12-lead ECG and focused transthoracic echocardiography (fTTE). LVH was defined as LVMI &gt; 95 g\/m\u00b2 in women, and &gt;115 g\/m\u00b2 in men. Diagnostic performance of multiple ECG-LVH criteria was assessed using correlation analyses, sensitivity and specificity estimates, receiver-operating characteristic (ROC) analysis, including calculation of the area under the ROC curve (AUROC), and precision-recall curves (PRC).\nResults: Echocardiographic LVH was present in 56 (5%) participants. Across continuous ECG indices, Cornell voltage product adjusted by +0.8 mV in women showed the strongest association with LVMI (Spearman\u2019s rho = 0.37, p &lt; 0.001). Among evaluated criteria, Cornell voltage product-based measures demonstrated the most consistent diagnostic performance across evaluated metrics, with an AUROC of approximately 0.76. Using established cut-off values, this criterion yielded a sensitivity of 64% and a specificity of 80%, whereas voltage-only criteria, including Multi-Ethnic Study of Atherosclerosis (MESA)- and Sokolow\u2013Lyon-based indices, showed limited accuracy in this setting. Exploratory analyses of alternative cut-off values demonstrated the expected sensitivity\u2013specificity trade-offs.\nConclusions: In this cohort of hypertensive Black African adults, ECG criteria showed a moderate association with LVMI by echocardiography. Among established ECG criteria, Cornell voltage product-based measures demonstrated the most consistent diagnostic performance. Diagnostic characteristics were strongly influenced by cut-off selection and clinical context, underscoring the need for population-specific evaluation and external validation of ECG criteria for LVH in African settings.\nTrial registration: Clinicaltrials.gov NCT04129840. Registered on October 17, 2019 (https:\/\/www.clinicaltrials.gov\/).<\/jats:p>","DOI":"10.5334\/gh.1562","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T12:16:43Z","timestamp":1784636203000},"page":"57","source":"Crossref","is-referenced-by-count":0,"title":["ECG Criteria for Left Ventricular Hypertrophy in Hypertensive Black Africans: Insights from the coArtHA Trial"],"prefix":"10.5334","volume":"21","author":[{"given":"Annina S.","family":"Vischer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7916-3168","authenticated-orcid":false,"given":"Valeriya","family":"Nemtsova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5373-4747","authenticated-orcid":false,"given":"Blaise","family":"Lukau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0547-1923","authenticated-orcid":false,"given":"Martin","family":"Rohacek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Macko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9518-6619","authenticated-orcid":false,"given":"Johanna","family":"Oehri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7753-464X","authenticated-orcid":false,"given":"Herry","family":"Mapesi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8908-0953","authenticated-orcid":false,"given":"Fiona","family":"Vanobberghen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6221-8409","authenticated-orcid":false,"given":"Andrew","family":"Katende","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herieth Ismael","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1716-993X","authenticated-orcid":false,"given":"Alain","family":"Amstutz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6029-8249","authenticated-orcid":false,"given":"Elizabeth","family":"Senkoro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theonestina","family":"Byakuzana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geofrey","family":"Mbunda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1449-5734","authenticated-orcid":false,"given":"Jamali","family":"Siru","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6881-6896","authenticated-orcid":false,"given":"Winfrid","family":"Gingo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3599-1791","authenticated-orcid":false,"given":"Niklaus Daniel","family":"Labhardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0134-1929","authenticated-orcid":false,"given":"Maja","family":"Weisser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6373-9820","authenticated-orcid":false,"given":"Thilo","family":"Burkard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3285","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"issue":"10","key":"key20260721121639_B1","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1016\/j.amjmed.2008.05.034","article-title":"Left ventricular hypertrophy and cardiovascular mortality by race and ethnicity","volume":"121","year":"2008","journal-title":"Am J Med"},{"issue":"10","key":"key20260721121639_B2","first-page":"e251","article-title":"AHA\/ACCF\/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; 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