Key result
The novel RLI + SV4 electrocardiographic criteria demonstrated a higher area under the curve (0.76) for diagnosing left ventricular hypertrophy than the Sokolow-Lyon (0.61) and SD + SV4 (0.63) criteria.
Why the study?
Diagnostic criteria for left ventricular hypertrophy have low sensitivity, and whether the recently proposed SD + SV4 formula improves sensitivity in the Japanese general population was unknown.
Does the novel RLI + SV4 ECG criteria improve diagnostic accuracy for left ventricular hypertrophy compared to traditional criteria in the Japanese general population?
Cross-Sectional (n=866)
No
Does the novel RLI + SV4 ECG criteria improve diagnostic accuracy for left ventricular hypertrophy compared to traditional criteria in the Japanese general population?
The novel RLI + SV4 ECG criteria provide better diagnostic accuracy for left ventricular hypertrophy than several traditional criteria in the Japanese general population.
May support refined ECG screening for LVH in Japanese adults; leaves open prospective validation and outcome impact.
Although there are several diagnostic criteria for left ventricular hypertrophy (LVH), their sensitivity remains low. A recent study reported that the sum of the amplitude of the deepest S wave in any lead (SD) and the S wave in lead V4 (SV4) (SD + SV4) improved sensitivity compared with commonly used criteria. To test whether this new formula improves sensitivity in the Japanese general population, we analyzed 12-lead electrocardiograms for Japanese residents participating in the Iwaki Health Promotion Project (n = 866). Left ventricular mass was calculated by echocardiography, indicating that 156 (18%) of the study population had LVH. In receiver operating characteristic analyses, the sum of the R wave in limb lead Ι (RLΙ) and the S wave in V4 (SV4) (RLΙ + SV4) showed a higher area under the curve (AUC = 0.76) than the Sokolow-Lyon voltage criteria (0.61) and the SD + SV4 criteria (0.63), and almost the same AUC as the Cornell voltage criteria (0.74) and the Cornell product criteria (0.76). The validation study also showed similar results. The cutoff values of RLΙ + SV4 criteria were ≥1.6 mV in men and ≥1.4 mV in women with a sensitivity of 39% and a specificity of 89%, whereas the sensitivity and specificity calculated based on SD + SV4 criteria were 21% and 94%, respectively. Thus, the diagnostic criterion of RLΙ + SV4 seems to be more useful than the previous criteria for diagnosing LVH in the Japanese general population.
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Narita et al. (2019) conducted a cross-sectional in Left ventricular hypertrophy (n=866). RLI + SV4 electrocardiographic criteria vs. Sokolow-Lyon, SD + SV4, and Cornell criteria was evaluated on Area under the curve (AUC) for diagnosing left ventricular hypertrophy (AUC 0.76, p=<0.01). The novel RLI + SV4 electrocardiographic criteria demonstrated a higher area under the curve (0.76) for diagnosing left ventricular hypertrophy than the Sokolow-Lyon (0.61) and SD + SV4 (0.63) criteria.
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