Key result
Modified limb electrode positions can detect left ventricular hypertrophy; correcting aVL increased Cornell voltage criteria sensitivity from 15% to 30% while maintaining 95% specificity.
Why the study?
Does the use of modified limb electrode positions affect the diagnostic accuracy of traditional ECG criteria for left ventricular hypertrophy in patients with stable angina pectoris?
Observational (n=518)
Does the use of modified limb electrode positions affect the diagnostic accuracy of traditional ECG criteria for left ventricular hypertrophy in patients with stable angina pectoris?
ECGs registered with modified limb electrode positions can be used to detect LVH, but changes in limb leads are considerable and require correction (e.g., aVL) to optimize sensitivity.
Modified limb positions with aVL correction may raise Cornell sensitivity in stable angina; leaves open prospective validation before practice change.
BACKGROUND: Left ventricular hypertrophy (LVH) in coronary heart disease is associated with poor prognosis. Electrocardiography (ECG) criteria for LVH, when using ECG with modified limb electrode positions, has not been validated in patients with angina pectoris. METHODS: Echocardiography and resting ECGs with modified limb electrode positions, i.e. with the limb leads placed on the abdomen instead of the extremities, were registered from 468 patients (295 men) with stable angina pectoris. To evaluate the influence of using modified limb electrode positions, ECGs with standard and modified limb electrode positions were compared in a control group consisting of 50 other patients. RESULTS: The ECG criteria for LVH according to the Perugia score, the Minnesota code and Romhilt & Estes reached the highest sensitivity values, 27-31% in men and 24-38% in women, while the sensitivities of different Cornell criteria were as low as 6-10% in men and 19-29% in women. In the control group, the R- and S-wave amplitudes of the precordial leads were only slightly changed, as expected, whereas those of the limb leads changed considerably. Based on these results, we corrected aVL in the main study, which increased the sensitivity of the Cornell voltage criteria from 15 to 30%, while the specificity was maintained at 95%. CONCLUSIONS: ECGs registered with modified limb electrode positions can be used to detect LVH with traditional ECG criteria, but changes in the limb leads are considerable and influence the sensitivities.
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Malmqvist et al. (2001) conducted an observational in Stable angina pectoris (n=518). Modified limb electrode positions vs. Standard limb electrode positions was evaluated on Sensitivity and specificity of ECG criteria for left ventricular hypertrophy. Modified limb electrode positions can detect left ventricular hypertrophy; correcting aVL increased Cornell voltage criteria sensitivity from 15% to 30% while maintaining 95% specificity.
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