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

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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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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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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USEFULNESS OF ECG CRITERIA TO RULE OUT LEFT VENTRICULAR HYPERTROPHY IN OLDER INDIVIDUALS WITH TRUE LEFT BUNDLE BRANCH BLOCK

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2021.07.105 ◽

2021 ◽

Vol 37 (10) ◽

pp. S51

Author(s):

C Tavares ◽

N Samesima ◽

F Lazar Neto ◽

L Abrahão Hajjar ◽

L Godoy ◽

...

Keyword(s):

Left Ventricular Hypertrophy ◽

Left Bundle Branch Block ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Older Individuals ◽

Bundle Branch Block ◽

Ecg Criteria ◽

Rule Out

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

Paediatrica Indonesiana ◽

10.14238/pi35.5-6.1995.132-40 ◽

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.

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