Diagnostic performance of electrocardiographic criteria in echocardiographic diagnosis of different patterns of left ventricular hypertrophy

1. The sensitivity and specificity of four sets of electrocardiographic criteria for detection of left ventricular hypertrophy were evaluated in an echocardiographic study of 100 hypertensive patients. 2. All criteria gave reasonable specificity (87–94%) but poor sensitivity (39–52%). 3. When non-obese and obese patients were studied separately, criteria based on chest lead voltages were more sensitive than limb lead criteria for detection of left ventricular hypertrophy in non-obese subjects; however, the reverse was true in obese hypertensive patients, where criteria based on limb lead voltages were more sensitive than chest lead voltage criteria. 4. These data suggest that stratification of subjects by body build might improve the diagnostic performance of the electrocardiogram for detection of left ventricular hypertrophy.

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Improved diagnostic performance on the severity of left ventricular hypertrophy with body surface mapping.

Circulation ◽

10.1161/01.cir.79.2.312 ◽

1989 ◽

Vol 79 (2) ◽

pp. 312-323 ◽

Cited By ~ 20

Author(s):

M Yamaki ◽

K Ikeda ◽

I Kubota ◽

K Nakamura ◽

K Hanashima ◽

...

Keyword(s):

Left Ventricular Hypertrophy ◽

Body Surface ◽

Diagnostic Performance ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Body Surface Mapping ◽

Surface Mapping

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

Scientific Reports ◽

10.1038/s41598-021-91083-9 ◽

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.

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Radiomic Analysis of Native T1 Mapping Images for Differential Diagnosis of Left Ventricular Hypertrophy Etiologies

Iranian Journal of Radiology ◽

10.5812/iranjradiol.113335 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Chenao Zhan ◽

Dazhong Tang ◽

Lu Huang ◽

Yayuan Geng ◽

Tao Ai ◽

...

Keyword(s):

Differential Diagnosis ◽

Left Ventricular Hypertrophy ◽

Diagnostic Performance ◽

Ventricular Hypertrophy ◽

T1 Mapping ◽

Left Ventricular ◽

Test Dataset ◽

Mapping Model ◽

Independent Test ◽

Independent Test Dataset

Background: The clinical manifestations of amyloid cardiomyopathy (AC) are not specific; therefore, AC is often misdiagnosed as hypertrophic cardiomyopathy (HCM) or hypertensive heart disease (HHD). A differential diagnosis of these three conditions is often necessary in the clinical setting. Objectives: To investigate the differential diagnostic performance of radiomic analysis, based on cardiac magnetic resonance (CMR) native T1 mapping images for the left ventricular hypertrophy (LVH) etiologies. Methods: This retrospective, case-control study was conducted on 91 participants (68 males and 23 females; mean age: 48 ± 13 years), including 22 patients with HHD, 27 patients with AC, 28 patients with HCM, and 14 controls in Tongji Hospital (Shanghai, China). All participants underwent 3.0T CMR imaging. Besides, radiomic analyses were performed using T1 mapping images. The cases were divided into training and test datasets using a random seed. Next, the models were constructed with the training dataset and evaluated with the test dataset. Results: A total of 1,033 radiomic features were extracted in this study. Overall, 11, 28, 19, and eight features were selected to construct the basal T1 mapping, mid-chamber T1 mapping, apical T1 mapping, and multi-module conjoint models, respectively. Optimal performance was reported in the mid-chamber and basal T1 mapping models. The area under the curve (AUC), precision, recall, and F1 score were 0.96, 0.84, 0.82, and 0.83 for the mid-chamber T1 mapping model and 0.96, 0.90, 0.89, and 0.88 for the basal T1 mapping model in the independent test dataset, respectively. The lowest diagnostic performance was observed in the apical T1 mapping model. The AUC, precision, recall, and F1 score of the apical T1 mapping model were 0.86, 0.71, 0.70, and 0.70 in the independent test dataset, respectively. Conclusions: The radiomic analysis of T1 mapping could accurately distinguish the three causes of myocardial hypertrophy, including HCM, HHD, and AC. It may be also a suitable alternative to late gadolinium enhancement-CMR.

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Diagnostic performance of electrocardiographic criteria for left ventricular hypertrophy among various body mass index groups compared to diagnosis by cardiac magnetic resonance imaging

Annals of Noninvasive Electrocardiology ◽

10.1111/anec.12635 ◽

2019 ◽

Vol 24 (4) ◽

Cited By ~ 1

Author(s):

Veerawat Nomsawadi ◽

Rungroj Krittayaphong

Keyword(s):

Magnetic Resonance Imaging ◽

Body Mass Index ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Left Ventricular Hypertrophy ◽

Cardiac Magnetic Resonance Imaging ◽

Diagnostic Performance ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Resonance Imaging

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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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Left Ventricular Hypertrophy

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2014.marapr04 ◽

2014 ◽

Vol 19 (2) ◽

pp. 11-15

Author(s):

Steven L. Demeter

Keyword(s):

Risk Factors ◽

Left Ventricular Hypertrophy ◽

Ventricular Hypertrophy ◽

Left Ventricular Mass Index ◽

Medical Science ◽

Careful Analysis ◽

Left Ventricular ◽

Hypertensive Disease ◽

Accurate Analysis ◽

Clear Explanation

Abstract The fourth, fifth, and sixth editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) use left ventricular hypertrophy (LVH) as a variable to determine impairment caused by hypertensive disease. The issue of LVH, as assessed echocardiographically, is a prime example of medical science being at odds with legal jurisprudence. Some legislatures have allowed any cause of LVH in a hypertensive individual to be an allowed manifestation of hypertensive changes. This situation has arisen because a physician can never say that no component of LVH was not caused by the hypertension, even in an individual with a cardiomyopathy or valvular disorder. This article recommends that evaluators consider three points: if the cause of the LVH is hypertension, is the examinee at maximum medical improvement; is the LVH caused by hypertension or another factor; and, if apportionment is allowed, then a careful analysis of the risk factors for other disorders associated with LVH is necessary. The left ventricular mass index should be present in the echocardiogram report and can guide the interpretation of the alleged LVH; if not present, it should be requested because it facilitates a more accurate analysis. Further, if the cause of the LVH is more likely independent of the hypertension, then careful reasoning and an explanation should be included in the impairment report. If hypertension is only a partial cause, a reasoned analysis and clear explanation of the apportionment are required.

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