ECG Criteria for Left Ventricular Hypertrophy in Hypertensive Black Africans: Insights from the coArtHA Trial.
AS, V., V, N., B, L., M, R., J, M., J, O., H, M., F, V., A, K., & R, G. (2026). ECG Criteria for Left Ventricular Hypertrophy in Hypertensive Black Africans: Insights from the coArtHA Trial.. Global heart. https://doi.org/10.5334/gh.1562
AS V, V N, B L, M R, J M, J O, et al. ECG Criteria for Left Ventricular Hypertrophy in Hypertensive Black Africans: Insights from the coArtHA Trial.. Global heart. 2026; doi: 10.5334/gh.1562
AS V, V N, B L, et al. ECG Criteria for Left Ventricular Hypertrophy in Hypertensive Black Africans: Insights from the coArtHA Trial.[J]. Global heart. 2026. DOI: 10.5334/gh.1562.
@article{as2026,
author = {Vischer AS and Nemtsova V and Lukau B and Rohacek M and Macko J and Oehri J and Mapesi H and Vanobberghen F and Katende A and Gupta R},
title = {ECG Criteria for Left Ventricular Hypertrophy in Hypertensive Black Africans: Insights from the coArtHA Trial.},
journal = {Global heart},
year = {2026},
doi = {10.5334/gh.1562},
note = {PMID: 42499811},
}
TY - JOUR AU - Vischer AS AU - Nemtsova V AU - Lukau B AU - Rohacek M AU - Macko J AU - Oehri J AU - Mapesi H AU - Vanobberghen F AU - Katende A AU - Gupta R TI - ECG Criteria for Left Ventricular Hypertrophy in Hypertensive Black Africans: Insights from the coArtHA Trial. T2 - Global heart PY - 2026 DO - 10.5334/gh.1562 AN - PMID:42499811 ER -
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. OBJECTIVE: 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. METHODS: 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 > 95 g/m² in women, and >115 g/m² 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). RESULTS: 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's rho = 0.37, p < 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-Lyon-based indices, showed limited accuracy in this setting. Exploratory analyses of alternative cut-off values demonstrated the expected sensitivity-specificity trade-offs. CONCLUSIONS: 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. TRIAL REGISTRATION: Clinicaltrials.gov NCT04129840. Registered on October 17, 2019 (https://www.clinicaltrials.gov/).