Calculating Cornell voltage from nonstandard chest electrode recording site in the Reasons for Geographic And Racial Differences in Stroke study

Soliman, Elsayed Z.; Howard, George; Prineas, Ronald J.; McClure, Leslie A.; Howard, Virginia J.

doi:10.1016/j.jelectrocard.2009.10.002

« Previous Next »Journal of Electrocardiology
Volume 43, Issue 3 , Pages 209-214, May 2010

Calculating Cornell voltage from nonstandard chest electrode recording site in the Reasons for Geographic And Racial Differences in Stroke study☆

Elsayed Z. Soliman, MD, MSc, MS
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem NC, USA
- Corresponding author. Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest University School of Medicine, 2000 West First St., Piedmont Plaza 2, Suite 505, Winston Salem, NC 27104, USA.
George Howard, DrPH
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
Ronald J. Prineas, MD, PhD
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem NC, USA
Leslie A. McClure, PhD
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
Virginia J. Howard, PhD
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

Received 31 August 2009 published online 10 December 2009.

Abstract

Background

To minimize participants' burden and the need for disrobing, a 7-lead electrocardiogram (ECG) recording using a single mid-sternal chest lead was recorded at the initial stages of The REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Electrocardiogram-detected left ventricular hypertrophy (ECG-LVH) by Cornell voltage (RaVL + S-wave amplitude in V₃ [SV₃]) cannot be assessed from this method because of the absence of V₃. We examined the possibility that the S-wave amplitude in the mid-sternal lead (SV) could be used as a surrogate for SV₃.

Methods

The REGARDS study is a US national study where 7-lead ECGs were performed in 8,330 (29%) participants and standard 12-lead EGCs were performed in 20 811 (71%). Cornell voltage was calculated as the sum of aVL amplitude + SV (in the 7-lead group) or SV₃ (in the 12-lead group). Logistic regression analysis was used to examine and compare the magnitude of the association between the LVH risk factors with ECG-LVH in both groups, and Cox proportional hazards analysis was used to examine and compare the hazard ratios of overall mortality and cardiovascular mortality associated with ECG-LVH in both groups.

Results

Regardless of the Cornell voltage calculation method, ECG-LVH was significantly associated with LVH risk factors; and with the exception of sex, there was no evidence of a difference in the magnitude of the association. ECG-LVH from both approaches were significantly and similarly associated with both all-cause and cardiovascular mortality.

Conclusion

ECG-LVH by Cornell voltage calculated from a 7-lead ECG (using SV in the formula) has demographic and clinical associations that are similar to that calculated from a standard 12-lead ECG (using SV₃). In epidemiologic studies recording 7-lead ECG, SV could be used as an alternative to SV₃ in the Cornell voltage formula.