scholarly journals Sensitivity and Specificity of Electrocardiographic Criteria for Left Ventricular Hypertrophy in Children with Rheumatic Heart Disease

2019 ◽  
Vol 31 (9-10) ◽  
pp. 233-44 ◽  
Author(s):  
Sudigdo Sastroasmoro ◽  
Bambang Madiyono ◽  
Ismet N. Oesman
Keyword(s):  
Heart Disease ◽  
Left Ventricular Hypertrophy ◽  
Confidence Interval ◽  
Rheumatic Heart Disease ◽  
Ventricular Hypertrophy ◽  
Pediatric Patients ◽  
High Specificity ◽  
Left Ventricular ◽  
Diagnostic Modality ◽  
Rheumatic Heart

Electrocardiographic criteria for left ventricular hypertrophy (L VH) were examined in 84 unselected pediatric patients with rheumatic heart disease. There were 47 male and 3 7 female patients, ranging in age from 6 to 19 years. Electrocardiographic L VH was detected m 41 patients (48.8%), i.e. in 55.3% (26/47) of boys and in 36.6% (15/41) of girls. Echocardiographically determined L VH was present in 42 cases (50%) if left ventricular mass (L VM) was indexed for height, or 47 cases (56%) if L VM was indexed for body surface area (BSA). The overall sensitivity of height-indexed electrocardiographic diagnosis of LVH was 71.4% (95% confidence interval= 57.7% to 85.1%), while its sensitivity was 73.8% (95% confidence interval= 60.0% to 87.0%). For BSA indexed echocardiographic LVH, the sensitivity was 68.1% (95% confidence interval = 54.8 to 81.4%) and the specificity was 75.7% (95% confidence interval = 61.9% to 89.5%). When sex-adjustment was examined, there was no increase of sensitivity of electrocardiographic LVH. Sensitivity of the electrocardiogram for LVH increased when age-adjustment was examined with 13 years of age as a cut-off point, both for height indexed and BSA-indexed echocardiographic LVH. Reasons/or the difference between these findings and the findings in adult patients (remarkably low sensitivity and very high specificity of ECG L VH) were discussed. Electrocardiogram was a moderate diagnostic modality in the detection of L VH in our pediatric patients with rheumatic heart disease. Sex did not influence the sensitivity of ECG L VH, but older age group tended to increase its sensitivity.

P1772Diagnostic accuracy of a novel electrocardiographic criterion for the diagnosis of left ventricular hypertrophy in hypertrophic cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P M Azevedo ◽  
C Guerreiro ◽  
R Ladeiras-Lopes ◽  
R Faria ◽  
N Ferreira ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Left Ventricular Hypertrophy ◽  
Wall Thickness ◽  
Ventricular Hypertrophy ◽  
High Specificity ◽  
Left Ventricular ◽  
S Wave ◽  
Diagnostic Modality ◽  
Maximum Wall Thickness ◽  
Higher Sensitivity

Abstract Introduction The 12-lead electrocardiogram (ECG) is a fundamental initial diagnostic modality for the early evaluation of a patient suspected of having hypertrophic cardiomyopathy (HCM). ECG criteria for the diagnosis of left ventricular hypertrophy (LVH) typically have low sensitivity and high specificity. Recently, a novel ECG criterion (Peguero-Lo Presti, PLP) with higher sensitivity (62%) and similar specificity (90%) was developed in a cohort of hypertensive patients, but its accuracy in patients with HCM has not been tested. We hypothesized that Peguero-Lo Presti criterion would improve upon the sensitivity of other criteria, while maintaining high specificity, for the diagnosis of LVH in patients for with HCM. Methods We retrospectively analyzed 215 consecutive patients who underwent cardiac magnetic resonance (CMR) between 2010 and 2018 for suspected HCM. All patients aged 18 years or older, who had CMR-confirmed HCM and an ECG without confounders (complete left or right bundle brunch block or paced ventricular rhythm) were included for analysis (n=88). Left ventricular mass (LVM) index and maximum wall thickness were derived from CMR analysis. The PLP criteria was defined as the sum of the deepest S wave (SD) in any lead and the S wave amplitude of lead V4 (SV4). Cornell voltage (CL) and Sokolow-Lyon (SL) were used for comparison. We randomly selected 88 gender-matched patients who performed an ECG and CMR for other clinical reasons and who had no structural heart disease or LVH for use as controls. The DeLong and McNemar's test were used to compare ROC area under the curve (AUC) and sensitivity and specificity, respectively, between the three criteria. Results 88 patients with HCM (63% male, mean age 56.7±15 years) were analyzed. The mean maximum wall thickness was 19.9±4.4mm and mean indexed LVM was 89.7±27g/m2. 34 patients (38.6%) had increased indexed LVM and 77 (87.5%) had at least one segment with late gadolinium enhancement (LGE). Discrimination by AUC was highest for PLP (0.85 [95% CI 0.8–0.9]), compared to CL (0.79, p=0.03) and SL (0.73, p=0.02). Using literature cut-offs, the sensitivity of PLP (60% [95% CI 50–70%]) was significantly higher compared to CL (40% [95% CI 30–50%, p<0,001) and SL (41%, [95% CI 31–51%], p=0.01), whilst maintaining high specificity (PLP 96%; CL 98%; SL 94%). After adjusting for LVM, the amount of LGE had a positive correlation with PLP amplitude (Spearman's rho=0.6, coef=2.4, p=0.01), but not Cornell or Sokolow. The sensitivity of PLP was significantly higher than CL and Sokolow in patients with LGE (61% vs 44% vs 43%, p<0.05). Conclusion The Peguero-Lo Presti criteria demonstrated higher sensitivity and similar specificity when compared to the Cornell and Sokolow-Lyon criteria for the diagnosis of LVH in a cohort of patients with hypertrophic cardiomyopathy. Therefore, they could become the standard ECG diagnostic criteria in patients suspected of having LVH and HCM.

scholarly journals POLYMORPHISM OF TOLL-LIKE RECEPTORS-2 IN PATIENTS WITH CHRONIC RHEUMATIC HEART DISEASE

2021 ◽  
Vol 9 (1) ◽  
pp. 51-58
Author(s):  
V.S. Petrov ◽  
◽  
А.А. Nikiforov ◽  
E.A. Smirnova ◽  
◽  
...  
Keyword(s):  
Heart Disease ◽  
Left Ventricular Hypertrophy ◽  
Right Ventricle ◽  
Left Atrium ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Orifice Area ◽  
Mitral Orifice ◽  
The Right ◽  
Rheumatic Heart

Aim. To assess the contribution of TLR2 gene polymorphism to echocardiography and spirometry parameters in patients with chronic rheumatic heart disease (CRHD). Materials and Methods. A total of 128 patients with CRHD were examined – 15.6% of men and 84.4% of women. Genotyping by polymorphic markers Arg753Arg, Arg753Gln, Gln753Gln was performed by PCR with SNP-EXPRESS electrophoretic scheme (NPF Litekh, Russia) for detection of the result after extraction of DNA from leukocytes of venous blood. Echocardiography with evaluation of linear dimensions, left ventricular hypertrophy and mitral orifice area was performed on Philips Affinity 50 apparatus; respiration was evaluated using Spirolab II spirometer. Results. The distance of the 6-minute walk test in the groups did not differ significantly: (р=0.168): Arg753Arg–314.75±6.88 m, Arg753Gln–389.69±19.92 m, as well as mitral orifice area (p=0.182): Arg753Arg–1.73(1.66;1.80) cm2 and Arg753Gln–1/70(1.61;1.79) cm2. Echocardiography showed no differences in the size of the left ventricle, but in the group of Arg753Gln heterozygotes, dilatation of the left atrium was significantly higher 5.20(5.08;5.32) cm (Arg753Arg-4.98(4.83;5.13) cm) and of the right ventricle 3.10(2.90;3.30) cm (Arg753Arg-2.66 (2.59;2.72) cm) and less pronounced values of the left ventricular hypertrophy: interventricular septum thickness 1.018(0.92;1.12) cm (Arg753Arg-1.02(0.98;1.05) cm) and of the right atrium 4.40(4.10;4.70) cm (Arg753Arg-4.54(4.33;4.74) cm). In spirometry, values of both obstructive and restrictive parameters were significantly lower in the Arg753Arg homozygous group: forced lung capacity 71.04(66.15;72.94)% (Arg753Gln-84.16(79.68;88,65)%); forced expiratory volume in 1 sec 79,05(76,87;81,23)% (Arg753Gln-88,18(84,40;91.96)%); reserve inspiratory volume 84.88(81.60;88.17)% (Arg753Gln-96.45(86.73;106.18)%); reserve expiratory volume 21.29 (18.08;24.51)% (Arg753Gln-25.93(13.93;37.93)%). Conclusion. In patients with RHD, the contribution of single TLR2 nucleotide replacements to the parameters of echocardiography and spirometry is possible, which is manifested in a decrease in external respiration function in Arg753Arg homozygotes and dilatation of the left atrium and right ventricle in Arg753Gln heterozygotes.

The polymorphism at the microRNA-155 binding site in AGTR1 gene is not significantly associated with rheumatic heart disease in Saudi Arabia population

MicroRNA ◽  
2020 ◽  
Vol 09 ◽  
Author(s):  
S. Justin Carlus ◽  
Fiona Hannah Carlus ◽  
Mazen Khalid Al-Harbi ◽  
Abdulhadi H Al-Mazroea ◽  
Khalid M Al- Harbi ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Clinical Features ◽  
Left Ventricular ◽  
Genotype Distribution ◽  
Allelic Discrimination ◽  
Children And Young Adults ◽  
And Control ◽  
Rheumatic Heart

Background: Rheumatic heart disease (RHD) remains a major cause of cardiovascular diseases and the most devastating effects are on children and young adults. RHD is caused due to the interaction between microbial, environmental, immunologic, and genetic factors. The renin-angiotensin aldosterone system (RAAS) has been strongly implicated as the susceptibility pathway in the pathogenesis of cardiovascular disease. Objective: The present study investigated the modulating effect of Angiotensin II type 1 receptor (AGTR1) 1166A>C polymorphism on the RHD and its clinical features in Saudi Arabia. Methods: AGTR1 1166A>C polymorphism was genotyped in 96 echocardiographically confirmed RHD patients and 142 ethnically matched controls by TaqMan allelic discrimination method. Results: Genotype distribution of the AGTR1 1166A>C polymorphism was not significantly different between RHD and control groups. Further, AGTR1 1166A>C genotypes are not associated with the clinical features of RHD. These data support that there was no evidence for an association between AGTR1 1166A>C polymorphism and RHD in Saudi Arabia. Conclusion: To our knowledge, this is the first study that has investigated the possible association between AGTR1 1166A>C polymorphism and susceptibility to RHD and its clinical features. Even though AGTR1 gene is 1166A>C (rs5186) was reported to be associated with hypertension, left ventricular hypertrophy and coronary heart disease. Present study did not find any association between AGTR1 1166A>C polymorphism and RHD in Saudi Arabia. Further studies are needed to confirm our findings.

Task shifting to clinical officer-led echocardiography screening for detecting rheumatic heart disease in Malawi, Africa

2016 ◽  
Vol 27 (6) ◽  
pp. 1133-1139 ◽  
Author(s):  
Amy Sims Sanyahumbi ◽  
Craig A. Sable ◽  
Melissa Karlsten ◽  
Mina C. Hosseinipour ◽  
Peter N. Kazembe ◽  
...  
Keyword(s):  
Heart Disease ◽  
Confidence Interval ◽  
Rheumatic Heart Disease ◽  
Task Shifting ◽  
Clinical Officer ◽  
Paediatric Cardiologist ◽  
Short Course ◽  
Κ Statistic ◽  
Clinical Officers ◽  
Rheumatic Heart

AbstractBackgroundEchocardiographic screening for rheumatic heart disease in asymptomatic children may result in early diagnosis and prevent progression. Physician-led screening is not feasible in Malawi. Task shifting to mid-level providers such as clinical officers may enable more widespread screening.HypothesisWith short-course training, clinical officers can accurately screen for rheumatic heart disease using focussed echocardiography.MethodsA total of eight clinical officers completed three half-days of didactics and 2 days of hands-on echocardiography training. Clinical officers were evaluated by performing screening echocardiograms on 20 children with known rheumatic heart disease status. They indicated whether children should be referred for follow-up. Referral was indicated if mitral regurgitation measured more than 1.5 cm or there was any measurable aortic regurgitation. The κ statistic was calculated to measure referral agreement with a paediatric cardiologist. Sensitivity and specificity were estimated using a generalised linear mixed model, and were calculated on the basis of World Heart Federation diagnostic criteria.ResultsThe mean κ statistic comparing clinical officer referrals with the paediatric cardiologist was 0.72 (95% confidence interval: 0.62, 0.82). The κ value ranged from a minimum of 0.57 to a maximum of 0.90. For rheumatic heart disease diagnosis, sensitivity was 0.91 (95% confidence interval: 0.86, 0.95) and specificity was 0.65 (95% confidence interval: 0.57, 0.72).ConclusionThere was substantial agreement between clinical officers and paediatric cardiologists on whether to refer. Clinical officers had a high sensitivity in detecting rheumatic heart disease. With short-course training, clinical officer-led echo screening for rheumatic heart disease is a viable alternative to physician-led screening in resource-limited settings.

Methods for detection of left ventricular hypertrophy: Application to hypertensive heart disease

1993 ◽  
Vol 14 (suppl D) ◽  
pp. 8-15 ◽  
Author(s):  
R. B. Devereux ◽  
M. J. Koren ◽  
G. de Simone ◽  
P. M. Okin ◽  
P. Kligfield
Keyword(s):  
Heart Disease ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Hypertensive Heart Disease ◽  
Left Ventricular

Effect of the timing of dialysis initiation on left ventricular hypertrophy and ınflammation in pediatric patients

2017 ◽  
Vol 32 (9) ◽  
pp. 1595-1602 ◽  
Author(s):  
Sevcan A. Bakkaloğlu ◽  
Yaşar Kandur ◽  
Erkin Serdaroğlu ◽  
Aytül Noyan ◽  
Aysun Karabay Bayazıt ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Pediatric Patients ◽  
Left Ventricular ◽  
Dialysis Initiation

Echocardiographic screening of pregnant women by non-physicians with remote interpretation in primary care

2020 ◽  
Author(s):  
Bruno R Nascimento ◽  
Craig Sable ◽  
Maria Carmo P Nunes ◽  
Kaciane K B Oliveira ◽  
Juliane Franco ◽  
...  
Keyword(s):  
Primary Care ◽  
Heart Disease ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Pregnant Women ◽  
Rheumatic Heart Disease ◽  
Morphological Changes ◽  
Severe Disease ◽  
Left Ventricular ◽  
Rheumatic Heart

Abstract Background Impact of heart disease (HD) on pregnancy is significant. Objective We aimed to evaluate the feasibility of integrating screening echocardiography (echo) into the Brazilian prenatal primary care to assess HD prevalence. Methods Over 13 months, 20 healthcare workers acquired simplified echo protocols, utilizing hand-held machines (GE-VSCAN), in 22 primary care centres. Consecutive pregnant women unaware of HD underwent focused echo, remotely interpreted in USA and Brazil. Major HD was defined as structural valve abnormalities, more than mild valve dysfunction, ventricular systolic dysfunction/hypertrophy, or other major abnormalities. Screen-positive women were referred for standard echo. Results At total, 1 112 women underwent screening. Mean age was 27 ± 8 years, mean gestational age 22 ± 9 weeks. Major HD was found in 100 (9.0%) patients. More than mild mitral regurgitation was observed in 47 (4.2%), tricuspid regurgitation in 11 (1.0%), mild left ventricular dysfunction in 4 (0.4%), left ventricular hypertrophy in 2 (0.2%) and suspected rheumatic heart disease in 36 (3.2%): all, with mitral valve and two with aortic valve (AV) involvement. Other AV disease was observed in 11 (10%). In 56 screen-positive women undergoing standard echo, major HD was confirmed in 45 (80.4%): RHD findings in 12 patients (all with mitral valve and two with AV disease), mitral regurgitation in 40 (14 with morphological changes, 10 suggestive of rheumatic heart disease), other AV disease in two (mild/moderate regurgitation). Conclusions Integration of echo screening into primary prenatal care is feasible in Brazil. However, the low prevalence of severe disease urges further investigations about the effectiveness of the strategy.

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