Key result
Peguero-Lo Presti ECG criteria yield ~56% accuracy for diagnosing LVH compared to echocardiogram.
Why the study?
ECG is an accessible, low-cost diagnostic alternative to echocardiography for LVH, but how different criteria perform compared with echocardiography remains to be evaluated.
Do electrocardiographic criteria accurately diagnose left ventricular hypertrophy compared to echocardiogram in clinical patients?
Cross-Sectional (n=142)
No
Do electrocardiographic criteria accurately diagnose left ventricular hypertrophy compared to echocardiogram in clinical patients?
Electrocardiographic criteria for LVH, including the newer Peguero-Lo Presti criteria, have high specificity but low sensitivity, making them suitable for confirming but not screening for LVH.
ECG criteria including Peguero-Lo Presti lack sensitivity for LVH screening; leaves open need for prospective validation or refined thresholds.
Left ventricular hypertrophy (LVH) is an adaptive mechanism of the cardiac muscle due to increased activity demand or functional overload. The echocardiogram (ECHO) presents a better performance in relation to the electrocardiogram (ECG) for the diagnosis of LVH. However, the ECG is a low-cost and easy-to-reproduce diagnostic alternative and can be useful in services and locations where the ECHO is not yet easily accessible. Recently, a new criterion for LVH was proposed by Peguero-Lo Presti. The aim of this article was to evaluate the electrocardiographic criteria for the diagnosis of LVH (Sokolow-Lyon, Cornell voltage, Romhilt-Estes, and Peguero-Lo Presti) in comparison to the diagnosis made by the ECHO. ECHO and ECG from 142 patients' medical records were analyzed. Patients were divided into three groups according to the ECHO - control, eccentric LVH, and concentric LVH. Sensitivity, specificity, PPV, NPV, and accuracy of the four electrocardiographic criteria were evaluated in three scenarios - (1) LVH vs control, (2) concentric LVH vs control, and (3) eccentric LVH vs control. Of the 142 patients included in the study, 100 (70.4%) had LVH. According to the type of hypertrophy, the 100 patients with LVH were divided into two groups - 41 (28.8%) had eccentric LVH and 59 (41.5%) had concentric LVH. Of all the scenarios, the Peguero-Lo Presti criteria obtained the best sensitivity (1, 41%; 2, 33,9%; 3, 51,2%) and accuracy (1, 56,3%; 2, 58,4%; 3, 69,8%). The Sokolow-Lyon criteria showed greater specificity in all analyses (100%). None of the electrocardiographic criteria obtained sensitivity values that would justify the use of the electrocardiogram as a screening test for LVH. No differences were found for eccentric and concentric LVH in terms of diagnosis using electrocardiographic criteria. We recommend the use of these criteria to confirm the diagnosis of LVH, especially in low-complexity services that do not have image-based diagnostic tests.
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Marcato et al. (2022) conducted a cross-sectional in Left ventricular hypertrophy (n=142). Electrocardiographic criteria (Peguero-Lo Presti, Sokolow-Lyon, Cornell, Romhilt-Estes) vs. Echocardiogram was evaluated on Accuracy of Peguero-Lo Presti criteria for diagnosing left ventricular hypertrophy. The Peguero-Lo Presti electrocardiographic criteria demonstrated the highest sensitivity (41%) and accuracy (56.3%) for diagnosing left ventricular hypertrophy compared to echocardiogram.
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