Marking ECG electrode positions with a dermographic pen significantly reduced the day-to-day LVH reclassification rate using Cornell voltage from 11% to 4% (P=0.040) compared to traditional placement.
RCT (n=276)
Randomized
Yes
Does marking ECG electrode positions with a dermographic pen improve the day-to-day reproducibility of electrocardiographic diagnosis of left ventricular hypertrophy in hypertensive patients?
Marking ECG electrode positions with a dermographic pen significantly improves the day-to-day reproducibility of standard voltage-based LVH criteria in hypertensive patients.
Absolute Event Rate: 4% vs 11%
p-value: p=0.040
OBJECTIVE: Although electrocardiography (ECG) is recommended in all subjects with hypertension, no information is available on the influence exerted by random changes in the placement of electrodes on the day-to-day variability of ECG criteria for diagnosis of left ventricular hypertrophy (LVH). METHODS: In a multicentre, randomized study, two standard 12-lead ECG were recorded, 24 h apart, from 276 consecutive hypertensive patients (mean age 65 +/- 12 years, 49.6% men). Overall, 142 patients were randomized to ECG with the position of electrodes marked on the skin using a dermographic pen and 134 to traditional ECG without marking the position of electrodes. Day-to-day variability of ECG criteria for LVH was compared between the two groups. RESULTS: Coefficients of variation (SD of the difference between paired voltage measurements divided by the mean value) varied consistently among subjects randomized to ECG without dermographic pen, ranging from 30% (R wave in lead I) to 81% (R wave in lead V5). Dermographic pen led to a lesser variability of ECG voltages with consequent reduction in the coefficients of variation, which ranged from 26% (R-wave amplitude in lead I) to 43% (R-wave amplitude in lead V5). The proportion of subjects who changed classification status for LVH ('reclassification rate') from the first to the second ECG session (LVH present in session 1 and absent in session 2, or vice versa) decreased for effect of dermographic pen from 11 to 4% (P = 0.040) with the Cornell voltage, from 19 to 11% (P = 0.029) with the Sokolow-Lyon voltage, and from 18 to 7% with the Romhilt-Estes criterion (P = 0.018), but not with other criteria. In particular, the typical strain and the Cornell strain were associated with the lowest reclassification rates regardless of dermographic pen. CONCLUSIONS: Random changes in the position of ECG electrodes strongly impair the day-to-day reproducibility of Cornell voltage, Sokolow-Lyon and Romhilt-Estes criteria for LVH. The typical strain and Cornell strain criteria showed a lesser spontaneous day-to-day variability.
Angeli et al. (Wed,) conducted a rct in Hypertension (n=276). ECG with electrode positions marked using a dermographic pen vs. Traditional ECG without marking electrode positions was evaluated on Reclassification rate for LVH using Cornell voltage criterion (p=0.040). Marking ECG electrode positions with a dermographic pen significantly reduced the day-to-day LVH reclassification rate using Cornell voltage from 11% to 4% (P=0.040) compared to traditional placement.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: