Secondary Logo

Institutional members access full text with Ovid®

Left ventricular hypertrophy identified by cardiac computed tomography and ECG in hypertensive individuals

a population-based study

Kühl, Jørgen Tobiasa; Nielsen, Jonas Billeb,c; Stisen, Zara Rebeccaa; Fuchs, Andreasa; Sigvardsen, Per Ejlstrupa; Graff, Clausd; Nordestgaard, Børge Grønnee; Køber, Lars Valeura; Kofoed, Klaus Fuglsanga,f

doi: 10.1097/HJH.0000000000001962
ORIGINAL PAPERS: Heart and vessels

Objectives: Screening of left ventricular hypertrophy (LVH) is a biomarker of organ damage in hypertensive individuals and associated with increased mortality. Cardiac computed tomography (CT) is widely expanding worldwide; however, the value of CT assessment of LVH is unknown. We aimed to identify individuals with LVH using both cardiac CT and electrocardiograms (ECG) and to explore potential differences between these phenotypical distinct diagnostic modalities.

Methods: Participants in the Copenhagen General Population Study underwent 12-lead ECG and cardiac CT and were evaluated for the presence of LVH. Multiple ECG signs of LVH were compared with LVH by CT.

Results: Out of 4942 participants, 1347 had untreated hypertension and in this group, 13% presented with anatomical LVH by CT and 10% by ECG with an overlap of 4%. ECG signs of LVH had negative predictive values between 87 and 89% compared with CT. Using a combination of the Sokolow-Lyon index, the Cornell voltage duration product and/or a Romhilt-Estes score at least 4, lead to an increased C-statistics (P < 0.001) compared with the use of any single ECG sign of LVH. Individuals with solely CT but not ECG signs of LVH had higher SBPs (152 vs. 144 mmHg, P < 0.001) and larger left atria (49 vs. 45 ml/m2, P < 0.001) compared with individuals with solely ECG LVH.

Conclusion: CT and ECG identifies LVH in 19% of hypertensive individuals with only a small diagnostic overlap. Commonly used ECG criteria for LVH cannot safely rule out the presence of anatomical LV organ damage.

aDepartment of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark

bDivision of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan

cDepartment of Human Genetics, USA

dDepartment of Health Science and Technology, Aalborg University

eDepartment of Clinical Biochemistry and the Copenhagen General Population Study, Herlev Hospital, University of Copenhagen

fDepartment of Radiology, Rigshospitalet, University of Copenhagen, Denmark

Correspondence to Jørgen Tobias Kühl, MD, PhD, Department of Cardiology, 9441 The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 94, 2100-CPH, Denmark. Tel: +45 21 97 48 88; e-mail:

Abbreviations: CT, computed tomography; LV, left ventricle; LVH, left ventricular hypertrophy; NPV, negative predictive value; PPV, positive predictive value; TTE, transthoracic echocardiography

Received 16 May, 2018

Accepted 12 September, 2018

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.