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

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

scholarly journals Diagnostic Accuracy of Electrocardiographic Criteria for Left Ventricular Hypertrophy in Thalassemia Syndrome

2018 ◽  
Vol 35 (5-6) ◽  
pp. 132-40
Author(s):  
Sudigdo Sastroasmoro ◽  
Deddy Ria Saputra ◽  
Bambang Madiyono ◽  
Ismet N. Oesman ◽  
Sukman Tulus Putra
Keyword(s):  
Child Health ◽  
Left Ventricular Hypertrophy ◽  
Diagnostic Accuracy ◽  
Body Surface ◽  
Gold Standard ◽  
Ventricular Hypertrophy ◽  
Thalassemia Major ◽  
Left Ventricular ◽  
Low Sensitivity ◽  
Ecg Criteria

We compared the diagnostic accuracy of electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) in 119 randomly selected from 400 patients with thalassemia major treated at the Department of Child Health, Medical School, University of Indonesia, Jakarta. Echocardiographically derived left ventricular hypertrophy (EchoLVH), both for body surface area (BSA)-indexed and height-indexed, served as the gold standard. There were 57 girls and 62 boys available, ranging in age from 5 to 27 years. ECG criteria for LVH was detected in 23 outof119 patients, while echo-LVH was detected in 47 patients if BSA-indexed LVH was used, or 22 patients if height-indexed LVH was used. The sensitivity and specificity of ECG-LVH were 25.5 and 84.7% respectively if BSA indexed LVH was used as gold standard, or 36.4% and 84.5%, respectively, when height indexed echo-LVH was used. It is concluded that ECG criteria for LVH has a low sensitivity and hjgh specificity in detecting increased left ventricular mass in children with thalassemia major.

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

2020 ◽  
Vol 33 (9) ◽  
pp. 831-836 ◽  
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.

Ventricular hypertrophy

ESC CardioMed ◽  
2018 ◽  
pp. 341-345
Author(s):  
Ljuba Bacharova ◽  
Harvey Estes
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Electric Field ◽  
Ventricular Hypertrophy ◽  
Strong Predictor ◽  
Left Ventricular ◽  
Clinical Value ◽  
Functional Measure ◽  
The Individual ◽  
Low Sensitivity ◽  
Ecg Criteria

The term ‘ventricular hypertrophy’ encompasses changes seen in a variety of cardiac pathological processes as well as in some physiological ones. The traditional concept involved in the electrocardiographic (ECG) diagnosis of ventricular hypertrophy assumes that an enlarged ventricular mass generates a stronger electrical field: in left ventricular hypertrophy the resultant electrical forces oriented posteriorly and leftward are augmented, resulting in an increase in amplitude in corresponding leads. An increased contribution of the right ventricle to the electric field enhances anterior and rightward-oriented forces. In spite of multiple attempts to improve the performance of ECG criteria, the classical ECG criteria for ventricular hypertrophies suffer from low sensitivity and questionable specificity. Traditionally, the strongest arguments advanced in favour of continued use of the ECG have been those related to convenience, availability, and low cost; nevertheless, they are inadequate justification for its use. However, the main problem is the effort to estimate the size/dimensions of ventricles by measuring the electric field. Valid justification must emphasize the added clinical value of the unique information provided by the ECG. The electrical information is a strong predictor of future cardiovascular disease and mortality, and the individual ECG abnormalities may be predictive of specific clinical presentations of disease. The anatomical measure of left ventricular hypertrophy by echocardiogram and magnetic resonance imaging, and functional measure by ECG are complementary information, and they are neither contradictory nor competing measures.

Ventricular hypertrophy

ESC CardioMed ◽  
2018 ◽  
pp. 341-345
Author(s):  
Ljuba Bacharova ◽  
Harvey Estes
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Electric Field ◽  
Ventricular Hypertrophy ◽  
Strong Predictor ◽  
Left Ventricular ◽  
Clinical Value ◽  
Functional Measure ◽  
The Individual ◽  
Low Sensitivity ◽  
Ecg Criteria

The term ‘ventricular hypertrophy’ encompasses changes seen in a variety of cardiac pathological processes as well as in some physiological ones. The traditional concept involved in the electrocardiographic (ECG) diagnosis of ventricular hypertrophy assumes that an enlarged ventricular mass generates a stronger electrical field: in left ventricular hypertrophy the resultant electrical forces oriented posteriorly and leftward are augmented, resulting in an increase in amplitude in corresponding leads. An increased contribution of the right ventricle to the electric field enhances anterior and rightward-oriented forces. In spite of multiple attempts to improve the performance of ECG criteria, the classical ECG criteria for ventricular hypertrophies suffer from low sensitivity and questionable specificity. Traditionally, the strongest arguments advanced in favour of continued use of the ECG have been those related to convenience, availability, and low cost; nevertheless, they are inadequate justification for its use. However, the main problem is the effort to estimate the size/dimensions of ventricles by measuring the electric field. Valid justification must emphasize the added clinical value of the unique information provided by the ECG. The electrical information is a strong predictor of future cardiovascular disease and mortality, and the individual ECG abnormalities may be predictive of specific clinical presentations of disease. The anatomical measure of left ventricular hypertrophy by echocardiogram and magnetic resonance imaging, and functional measure by ECG are complementary information, and they are neither contradictory nor competing measures.

scholarly journals Peguero–Lo Presti criteria modified by body surface area for the electrocardiographic diagnosis of left ventricular hypertrophy in Thai patients

2021 ◽  
Vol 15 (2) ◽  
pp. 101-107
Author(s):  
Wongsakorn Luangphiphat ◽  
Atthaphon Phaisitkriengkrai ◽  
Ratikorn Methavigul ◽  
Komsing Methavigul
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Ventricular Hypertrophy ◽  
Characteristic Curve ◽  
Left Ventricular ◽  
Lv Mass ◽  
Low Sensitivity ◽  
Ecg Criteria

Abstract Background Several electrocardiographic (ECG) criteria are used to diagnose left ventricular hypertrophy (LVH); however, they have low sensitivity. Objective To assess the sensitivity of LVH diagnosis using Peguero–Lo Presti criteria modified by body surface area (BSA). Methods This study used retrospective data from 9,438 patients who attended the Central Chest Institute of Thailand from January 2017 to December 2017 with available echocardiography, and who were categorized into those with and without LVH to determine diagnostic accuracy. We randomly selected 317 patients after excluding others based on various conditions. The left ventricular mass of the 317 patients was estimated using echocardiography. Peguero–Lo Presti criteria were modified by dividing original criteria by BSA. The accuracy of the modified criteria was compared with that of the original Peguero–Lo Presti, Sokolow–Lyon, and Cornell voltage criteria. A McNemar test was used to determine the agreement of all ECG criteria examined with LV mass index. The area under a receiver operating characteristic curve (AUC) was used to assess the performance of the criteria. Results LVH was diagnosed in 164 of the 317 patients using echocardiography. The sensitivity of modified Peguero–Lo Presti criteria was 50.6% (95% confidence interval [CI] 42.7% to 58.5%), and specificity was 88.2% (95% CI 82.0% to 92.9%), with an AUC of 0.67 (95% CI 0.61–0.73). Conclusions Peguero–Lo Presti criteria modified by dividing them by BSA can improve sensitivity with acceptable specificity for the diagnosis of LVH compared with other ECG criteria examined, at least in selected Thai patients. The modified Peguero–Lo Presti criteria have accuracy similar to that for the original criteria.

Left-Ventricular Hypertrophy in the Elderly: Unreliability of ECG Criteria in 477 Subjects Aged 65 Years or More

Cardiology ◽  
1996 ◽  
Vol 87 (5) ◽  
pp. 429-435 ◽  
Author(s):  
Edoardo Casiglia ◽  
Giorgia Maniati ◽  
Cosmas Daskalakis ◽  
Giovanna Colangeli ◽  
Paolo Tramontin ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
The Elderly ◽  
Left Ventricular ◽  
Ecg Criteria

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

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Caio de Assis Moura Tavares ◽  
Nelson Samesima ◽  
Ludhmila Abrahão Hajjar ◽  
Lucas C. Godoy ◽  
Eduardo Messias Hirano Padrão ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Diagnostic Performance ◽  
Ventricular Hypertrophy ◽  
Clinical Decision ◽  
Left Ventricular ◽  
Net Benefit ◽  
Decision Curve Analysis ◽  
Increased Sensitivity ◽  
Ecg Criteria ◽  
Threshold Range

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.

The Peguero--Lo Presti ECG criteria improve diagnostic accuracy of left ventricular hypertrophy in hypertrophic cardiomyopathy patients

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Coloma Tiron ◽  
Raul Ramos ◽  
Josep Iglesies ◽  
Anna Fernandez-Falgueras ◽  
Oscar Campuzano ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Left Ventricular Hypertrophy ◽  
Diagnostic Accuracy ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Ecg Criteria

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

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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