Clinical applicability and diagnostic performance of electrocardiographic criteria for left ventricular hypertrophy diagnosis in older adults

AbstractRecently, a new ECG criterion, the Peguero-Lo Presti (PLP), improved overall accuracy in the diagnosis of left ventricular hypertrophy (LVH)—compared to traditional ECG criteria, but with few patients with advanced age. We analyzed patients with older age and examined which ECG criteria would have better overall performance. A total of 592 patients were included (83.1% with hypertension, mean age of 77.5 years) and the PLP criterion was compared against Cornell voltage (CV), Sokolow-Lyon voltage (SL) and Romhilt-Estes criteria (cutoffs of 4 and 5 points, RE4 and RE5, respectively) using LVH defined by the echocardiogram as the gold standard. The PLP had higher AUC than the CV, RE and SL (respectively, 0.70 vs 0.66 vs 0.64 vs 0.67), increased sensitivity compared with the SL, CV and RE5 (respectively, 51.9% [95% CI 45.4–58.3%] vs 28.2% [95% CI 22.6–34.4%], p < 0.0001; vs 35.3% [95% CI 29.2–41.7%], p < 0.0001; vs 44.4% [95% CI 38.0–50.9%], p = 0.042), highest F1 score (58.3%) and net benefit for most of the 20–60% threshold range in the decision curve analysis. Overall, despite the best diagnostic performance in older patients, the PLP criterion cannot rule out LVH consistently but can potentially be used to guide clinical decision for echocardiogram ordering in low-resource settings.

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Usefulness of ECG criteria to rule out left ventricular hypertrophy in older individuals with true left bundle branch block: an observational study

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02332-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Caio Assis Moura Tavares ◽

Nelson Samesima ◽

Felippe Lazar Neto ◽

Ludhmila Abrahão Hajjar ◽

Lucas C. Godoy ◽

...

Keyword(s):

Left Ventricular Hypertrophy ◽

Diagnostic Accuracy ◽

Diagnostic Performance ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Curve Analysis ◽

Advanced Age ◽

Bundle Branch Block ◽

Decision Curve Analysis ◽

Ecg Criteria

Abstract Background Advanced age is associated with both left bundle branch block (LBBB) and hypertension and the usefulness of ECG criteria to detect left ventricular hypertrophy (LVH) in patients with LBBB is still unclear. The diagnostic performance and clinical applicability of ECG-based LVH criteria in patients with LBBB defined by stricter ECG criteria is unknown. The aim of this study was to compare diagnostic accuracy and clinical utility of ECG criteria in patients with advanced age and strict LBBB criteria. Methods Retrospective single-center study conducted from Jan/2017 to Mar/2018. Patients undergoing both ECG and echocardiogram examinations were included. Ten criteria for ECG-based LVH were compared using LVH defined by the echocardiogram as the gold standard. Sensitivity, specificity, predictive values, likelihood ratios, AUC, and the Brier score were used to compare diagnostic performance and a decision curve analysis was performed. Results From 4621 screened patients, 68 were included, median age was 78.4 years, (IQR 73.3–83.4), 73.5% with hypertension. All ECG criteria failed to provide accurate discrimination of LVH with AUC range between 0.54 and 0.67, and no ECG criteria had a balanced tradeoff between sensitivity and specificity. No ECG criteria consistently improved the net benefit compared to the strategy of performing routine echocardiogram in all patients in the decision curve analysis within the 10–60% probability threshold range. Conclusion ECG-based criteria for LVH in patients with advanced age and true LBBB lack diagnostic accuracy or clinical usefulness and should not be routinely assessed.

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The Peguero-Lo Presti criteria has the highest diagnostic accuracy for the diagnosis of left ventricular hypertrophy in the elderly

European Heart Journal ◽

10.1093/ehjci/ehaa946.3230 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C.A.M Tavares ◽

N Samesima ◽

L.A Hajjar ◽

L.C Godoy ◽

E.M.P Hirano ◽

...

Keyword(s):

Left Ventricular Hypertrophy ◽

Diagnostic Accuracy ◽

Ventricular Hypertrophy ◽

The Elderly ◽

Left Ventricular ◽

Accuracy Score ◽

Increased Sensitivity ◽

Low Sensitivity ◽

Ecg Criteria ◽

Improved Accuracy

Abstract Background Left Ventricular Hypertrophy (LVH) is an independent predictor of mortality and cardiovascular morbidity and the 12-lead ECG is recommended as a universal screening for patients with hypertension. However, the ECG has low sensitivity and there is limited data in patients 70 years or older. The recently published Peguero-Lo Presti (PLP) criteria had improved accuracy compared with other ECG criteria but with very few patients with age ≥70 years included. Purpose To compare the accuracy of the PLP criteria versus the traditional ECG criteria for detecting LVH in patients ≥70 years. Methods Retrospective single-center study. Patients were included if they were 70 years or older and underwent an ECG and echocardiogram (gold standard) less than 180 days apart from jan/2017 to mar/2018. Patients with left or right bundle branch block, non-sinus rhythm or ventricular paced rhythm were excluded. All tracings were independently reviewed by two cardiologists, blinded to the echocardiogram. The PLP criteria was compared against Cornell voltage (CV), Sokolow-Lyon voltage (SL), and Romhilt-Estes 4 and 5 (RE) criteria. LVH was defined as a left ventricular mass index >115 g/m2 in males and >95 g/m2 in females, according to the echocardiogram. McNemar's test, F1 score, and the area under the Receiver Operating Characteristic curves (AUC) were used to compare the diagnostic performance of the tests Results A total of 592 patients were included (mean age 77.5 years, SD: 5.9; 50.8% were women). The PLP criteria had increased sensitivity compared with both the SL and CV criteria (p<0.0001 for both comparisons) and RE5 (p=0.042). PLP also had better specificity than the RE4 criteria (p<0.0001) and the highest F1 accuracy score (Table 1). The AUC of the PLP was significantly higher than the AUC of the CV and RE criteria (0.70 vs 0.66 vs 0.64, respectively, p<0.05) and numerically higher than the SL criteria (AUC=0.67, p=0.311, Figure 1). Conclusion Compared to the traditional ECG criteria for LVH, the PLP criteria had the highest diagnostic accuracy in elderly patients. Figure 1. AUC of the ECG criteira Funding Acknowledgement Type of funding source: None

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Evaluation of ECG Criteria for Left Ventricular Hypertrophy Before and After Aortic Valve Replacement Using Magnetic Resonance Imaging

Journal of Cardiovascular Magnetic Resonance ◽

10.1081/jcmr-120022262 ◽

2003 ◽

Vol 5 (3) ◽

pp. 465-474 ◽

Cited By ~ 3

Author(s):

Hugo P. Beyerbacht ◽

Jeroen J. Bax ◽

Hildo J. Lamb ◽

Arnoud van der Laarse ◽

Hubert W. Vliegen ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Aortic Valve ◽

Left Ventricular Hypertrophy ◽

Aortic Valve Replacement ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Resonance Imaging ◽

Before And After ◽

Ecg Criteria

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USE OF A CARDIAC ELECTROCARDIOGRAPHY AND TRANSTHORACIC ECHOCARDIOGRAPHY DATABASE TO REDEFINE ECG CRITERIA FOR LEFT VENTRICULAR HYPERTROPHY (THE CREATED-LVH STUDY)

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(11)62032-9 ◽

2011 ◽

Vol 57 (14) ◽

pp. E2032

Author(s):

Sanjog Kalra ◽

Arnold Pinter ◽

Kamran Ahmad ◽

Victoria Korley ◽

Paul Dorian ◽

...

Keyword(s):

Left Ventricular Hypertrophy ◽

Transthoracic Echocardiography ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Ecg Criteria

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Performance of Electrocardiographic Criteria for Echocardiographically Diagnosed Left Ventricular Hypertrophy in Chinese Hypertensive Patients

American Journal of Hypertension ◽

10.1093/ajh/hpaa083 ◽

2020 ◽

Vol 33 (9) ◽

pp. 831-836 ◽

Cited By ~ 1

Author(s):

Dian Wang ◽

Jian-Zhong Xu ◽

Wei Zhang ◽

Yi Chen ◽

Jian Li ◽

...

Keyword(s):

Left Ventricular Hypertrophy ◽

Ventricular Hypertrophy ◽

High Specificity ◽

Left Ventricular ◽

Hypertensive Patients ◽

Receiver Operating Characteristic Curves ◽

Low Sensitivity ◽

Ecg Criteria ◽

Cornell Voltage ◽

Cornell Product

Abstract BACKGROUND Performance of electrocardiographic (ECG) criteria for echocardiographically diagnosed left ventricular hypertrophy (LVH) in Chinese hypertensive patients is not well known. We investigated the accuracy of various ECG criteria for the diagnosis of the echocardiographic LVH according to the new cutoff values of left ventricular mass (LVM) index (>115 g/m2 for men and >95 g/m2 for women) in Chinese hypertensive patients. METHODS Our study included 702 consecutive hypertensive inpatients including 92 (13.1%) concentric and 121 (17.2%) eccentric LVH on standard echocardiography. Diagnostic accuracy of 7 ECG criteria was evaluated by calculating sensitivity and specificity and by using the receiver operating characteristic curves. RESULTS The ECG criteria for the detection of the echocardiographically defined LVH had a sensitivity of 15%–31.9% and specificity of 91.6%–99.2% overall, 20.7%–43.5% and 91.6%–99.2% concentric, and 7.4%–23.1% and 91.6%–99.2% eccentric. ECG diagnosis of LVH defined as the positive diagnosis of any of 4 ECG criteria including Sokolow–Lyon voltage, Cornell voltage, Cornell product, and RavL voltage had a sensitivity of 54% and specificity of 86.3% overall, 71.7% and 86.3% concentric, and 40.5% and 86.3% eccentric. After adjustment for confounding factors, various ECG criteria were significantly correlated with LVM, with standardized β coefficients from 0.20 to 0.39 (P < 0.001) and the highest coefficient for the Cornell product criterion. CONCLUSIONS All ECG LVH indexes had low sensitivity and high specificity in Chinese hypertensive patients. Combination of 4 or all ECG criteria might improve sensitivity without any loss of specificity.

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