Improving the poor diagnostic accuracy of the ECG at detecting prognostically significant left ventricular hypertrophy in hypertensive patients

Background Normalised left ventricular mass (LVM) is a powerful prognostic tool. Traditionally, normalising has been achieved by indexing LVM to body surface area (BSA). A recent ‘Multiethnic Study of Atherosclerosis’ (MESA) sub-study demonstrated indexing LVM to height is more sensitive at identifying left ventricular hypertrophy (LVH) associated with cardiovascular events and all-cause death. We evaluated the ability of the ECG, an universal investigation in patients with hypertension, to detect LVH defined traditionally by LVM/BSA and by the prognostically more important LVM/height method using CMR (non-invasive gold-standard for LVM).