Key result
A diagnostic rule combining clinical factors, chest X-ray, and ECG yielded a higher c-statistic for detecting left ventricular hypertrophy than ECG alone (0.700 vs 0.522; P<0.001).
Why the study?
Electrocardiography is usually used to screen for left ventricular hypertrophy but is often insensitive, prompting development of a fortified detection rule incorporating cardiothoracic ratio and risk factors.
Does a fortified diagnostic rule combining clinical factors, chest X-ray, and ECG improve the detection of left ventricular hypertrophy compared to ECG alone in asymptomatic hypertensive adults?
Cross-Sectional (n=789)
Does a fortified diagnostic rule combining clinical factors, chest X-ray, and ECG improve the detection of left ventricular hypertrophy compared to ECG alone in asymptomatic hypertensive adults?
A simple scoring system combining clinical factors, chest X-ray, and ECG significantly improves the screening accuracy for left ventricular hypertrophy in asymptomatic hypertensive adults compared to ECG alone.
May aid LVH screening in asymptomatic hypertension; leaves open prospective validation before practice change.
Purpose. Left ventricular (LV) mass is determined by the wall thickness and diameter. LV hypertrophy (LVH), the increase in LV mass, is usually screened with electrocardiography but is often insensitive. We tried to fortify the rule to detect LVH using cardiothoracic ratio (CTR) in chest X-ray and well-known risk factors besides electrocardiography. Materials and Methods. This retrospective cross-sectional study included asymptomatic hypertensive individuals aged ≥40 y who underwent voluntary checkups including echocardiography. Independent variables to explain LVH (LV mass index>115 g/m 2 for men and >95 g/m 2 for women calculated on echocardiography) were chosen among Sokolow-Lyon voltage amplitude (SLVA), CTR and cardiovascular risk factors by multiple logistic regression analysis. The diagnostic rule to detect LVH was made by summing up the rounded-off odds ratio of each independent variable and was validated using bootstrapping method. Results. Among the 789 cases enrolled (202 females (25.6%), mean age 59.6±8.8 y), 168 (21.3%) had LVH. The diagnostic rule summed female, age≥65 y, BMI≥25 kg/m 2 , SLVA≥35 mm, and CTR≥0.50 (scoring 1 per each). Its c-statistics was 0.700 (95% CI: 0.653, 0.747), significantly higher ( p <0.001) than that of SLVA≥35 mm, 0.522 (95% CI: 0.472, 0.572). The sensitivity and specificity of the model were 61.9% and 72.1% for score≥2 and 30.4% and 92.9% for score≥3. The SLVA≥35 mm criteria showed sensitivity of 12.5% and specificity of 91.9%. Conclusions. The rule to sum up the number of the risk factors of female, age≥65 y, BMI≥25 kg/m 2 , SLVA≥35 mm, and CTR≥0.50 may be a better diagnostic tool for screening LVH, than the electrocardiography-only criteria, at the score≥2.
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Park et al. (2018) conducted a cross-sectional in Asymptomatic hypertension (n=789). Diagnostic rule combining clinical risk factors, SLVA, and CTR vs. SLVA ≥35 mm (electrocardiography-only criteria) was evaluated on c-statistic for detecting left ventricular hypertrophy (95% CI 0.653-0.747, p=<0.001). A diagnostic rule combining clinical factors, chest X-ray, and ECG yielded a higher c-statistic for detecting left ventricular hypertrophy than ECG alone (0.700 vs 0.522; P<0.001).
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