TY - JOUR

T1 - ECG and CT for the detection of left atrial enlargement in hypertensive individuals—a population-based study

AU - Nilsson, Emma Julia Petronella

AU - Kühl, Jørgen Tobias

AU - Nielsen, Jonas Bille

AU - Fuchs, Andreas

AU - Knudsen, Andreas Dehlbæk

AU - Sigvardsen, Per Ejlstrup

AU - Graff, Claus

AU - Køber, Lars

AU - Nordestgaard, Børge

AU - Kofoed, Klaus Fuglsang

N1 - Publisher Copyright: © 2022, The Author(s), under exclusive licence to The Japanese Society of Hypertension.

PY - 2022

Y1 - 2022

N2 - Left atrial enlargement (LAE) is associated with hypertension and an increased risk of cardiovascular morbidity and mortality. Guidelines for hypertension recommend LAE evaluation. We aimed to estimate the agreement of LAE as assessed by 12-lead electrocardiogram (ECG) and cardiac computed tomography (CT) in both the general population and hypertensive individuals. Cardiac CT and ECG were used to evaluate the presence of LAE in participants in the Copenhagen General Population Study. LAE, is defined as an LA volume above the 97.5% upper confidence limit by cardiac CT, as compared with multiple ECG criteria for LAE. A total of 3507 participants (47% males, age: 60 ± 10 years) were included. The prevalence of CT-defined LAE was 5.9% in the total population and 8.7% in participants with hypertension. In hypertensive individuals, LAE was identified by CT or by ECG in 31% with only a 4% overlap. ECG signs for anatomical LAE by CT had high negative predictive values between 93 and 96% but low sensitivity and positive predictive values. Specificity ranged from 27 to 93%. P-wave duration >120 ms was the best performing criterion, with a sensitivity of 48%, a specificity of 78%, and the highest area under the curve (0.66). We found a discrepancy in LAE prevalence when participants were assessed by CT and ECG, indicating that the two diagnostic modalities reflect different phenotypes of left atrial alterations. The diagnostic performance of ECG criteria for identifying anatomical LAE was poor.

AB - Left atrial enlargement (LAE) is associated with hypertension and an increased risk of cardiovascular morbidity and mortality. Guidelines for hypertension recommend LAE evaluation. We aimed to estimate the agreement of LAE as assessed by 12-lead electrocardiogram (ECG) and cardiac computed tomography (CT) in both the general population and hypertensive individuals. Cardiac CT and ECG were used to evaluate the presence of LAE in participants in the Copenhagen General Population Study. LAE, is defined as an LA volume above the 97.5% upper confidence limit by cardiac CT, as compared with multiple ECG criteria for LAE. A total of 3507 participants (47% males, age: 60 ± 10 years) were included. The prevalence of CT-defined LAE was 5.9% in the total population and 8.7% in participants with hypertension. In hypertensive individuals, LAE was identified by CT or by ECG in 31% with only a 4% overlap. ECG signs for anatomical LAE by CT had high negative predictive values between 93 and 96% but low sensitivity and positive predictive values. Specificity ranged from 27 to 93%. P-wave duration >120 ms was the best performing criterion, with a sensitivity of 48%, a specificity of 78%, and the highest area under the curve (0.66). We found a discrepancy in LAE prevalence when participants were assessed by CT and ECG, indicating that the two diagnostic modalities reflect different phenotypes of left atrial alterations. The diagnostic performance of ECG criteria for identifying anatomical LAE was poor.

KW - Computed tomography

KW - electrocardiogram

KW - hypertension

KW - left atrial enlargement

U2 - 10.1038/s41440-022-00918-z

DO - 10.1038/s41440-022-00918-z

M3 - Journal article

C2 - 35484267

AN - SCOPUS:85128972924

VL - 45

SP - 1382

EP - 1391

JO - Hypertension Research

JF - Hypertension Research

SN - 0916-9636

IS - 8

ER -