In hypertensive patients with CLBBB, standard ECG criteria for LVH showed decreased diagnostic performance, with Sokolow-Lyon voltage ≥3.0mV performing best (sensitivity 22.2%, specificity 88.3%).
Observational (n=2,240)
What is the diagnostic performance of electrocardiogram criteria for detecting left ventricular hypertrophy in hypertensive patients with complete left bundle branch block?
Standard ECG criteria for left ventricular hypertrophy have significantly reduced diagnostic performance in hypertensive patients with complete left bundle branch block, though Sokolow-Lyon ≥3.0mV performs best.
BACKGROUND: Left ventricular hypertrophy (LVH) is an important risk factor for cardiovascular events, and its detection usually begins with an electrocardiogram (ECG). OBJECTIVE: To evaluate the impact of complete left bundle branch block (CLBBB) in hypertensive patients in the diagnostic performance of LVH by ECG. METHODS: A total of 2,240 hypertensive patients were studied. All of them were submitted to an ECG and an echocardiogram (ECHO). We evaluated the most frequently used electrocardiographic criteria for LVH diagnosis: Cornell voltage, Cornell voltage product, Sokolow-Lyon voltage, Sokolow-Lyon product, RaVL, RaVL+SV3, RV6/RV5 ratio, strain pattern, left atrial enlargement, and QT interval. LVH identification pattern was the left ventricular mass index (LVMI) obtained by ECHO in all participants. RESULTS: Mean age was 11.3 years ± 58.7 years, 684 (30.5%) were male and 1,556 (69.5%) were female. In patients without CLBBB, ECG sensitivity to the presence of LVH varied between 7.6 and 40.9%, and specificity varied between 70.2% and 99.2%. In participants with CLBBB, sensitivity to LVH varied between 11.9 and 95.2%, and specificity between 6.6 and 96.6%. Among the criteria with the best performance for LVH with CLBBB, Sokolow-Lyon, for a voltage of ≥ 3,0mV, stood out with a sensitivity of 22.2% (CI 95% 15.8 - 30.8) and specificity of 88.3% (CI 95% 77.8 - 94.2). CONCLUSION: In hypertensive patients with CLBBB, the most often used criteria for the detection of LVH with ECG showed significant decrease in performance with regards to sensitivity and specificity. In this scenario, Sokolow-Lyon criteria with voltage ≥3,0mV presented the best performance.
Burgos et al. (Fri,) conducted a observational in Hypertension with and without complete left bundle branch block (n=2,240). Electrocardiogram (ECG) criteria for LVH vs. Echocardiogram (ECHO) left ventricular mass index was evaluated on Diagnostic performance (sensitivity and specificity) of ECG criteria for LVH. In hypertensive patients with CLBBB, standard ECG criteria for LVH showed decreased diagnostic performance, with Sokolow-Lyon voltage ≥3.0mV performing best (sensitivity 22.2%, specificity 88.3%).