Key result
Electrocardiography voltage criteria performed poorly in detecting left ventricular hypertrophy compared to echocardiography, with extremely low sensitivities ranging from 1.9% to 19.2%.
Why the study?
The study aimed to evaluate the diagnostic utility of widely used LVH ECG criteria compared with left ventricular mass measured by echocardiography.
Do ECG voltage criteria accurately diagnose left ventricular hypertrophy compared to transthoracic echocardiography in adults with increased blood pressure?
Cross-Sectional (n=165)
No
Do ECG voltage criteria accurately diagnose left ventricular hypertrophy compared to transthoracic echocardiography in adults with increased blood pressure?
Standard ECG voltage criteria have extremely low sensitivity and accuracy for diagnosing left ventricular hypertrophy and should not be relied upon for this purpose.
ECG LVH criteria show low sensitivity in ED adults; leaves open need for better screening tools before practice change.
OBJECTIVE/AIM: We aimed to evaluate the diagnostic utility of the widely used left ventricular hypertrophy (LVH) electrocardiography (ECG) criteria (Cornell Voltage Criteria [CVC], Sokolow-Lyon Index [SLI], Romhilt-Estes [REC], and Peguero-Lo Presti [PLP] Criteria) compared with the left ventricular mass measured by echocardiography. METHODS: In this prospective diagnostic accuracy study, we screened all consecutive adults (18 to 65 years) who presented to our academic emergency department (ED) with increased blood pressure (≥130/85 mmHg) between January 2016 and January 2017, and we enrolled a convenience sample of 165 patients in our study. The attending emergency physician managed all patients as per their primary complaint. The consulting cardiologist performed a transthoracic echocardiogram (TTE) of the patient and calculated the left ventricular mass (LVM) according to the American Society of Echocardiography (ASE) formula. After completing the patient recruitment phase, researchers evaluated all ECGs and calculated scores for SLI, CVC, REC, and PLP. We used contingency tables to calculate the diagnostic utility metrics of all ECG criteria. RESULTS: The prevalence of LVH by TTE was 31.5%. CVC, SLI, REC, and PLP criteria correctly identified (true positive rate) abnormal LVM in only 3.9%, 1.9%, 9.6%, and 19.2% of the patients, respectively. CVC, SLI, REC score and PLP criteria performed poorly with extremely low sensitivities (3.9%, 1.9%, 10%, 19.2%) and poor accuracies (67.3%, 64.9%, 57.7%, 69.7%). CONCLUSION: ECG voltage criteria's clinical utility in estimating LVM and LVH is low, and it should not be used for this purpose.
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Bayram et al. (2021) conducted a cross-sectional in Increased blood pressure (n=165). Electrocardiography criteria for left ventricular hypertrophy (CVC, SLI, REC, PLP) vs. Transthoracic echocardiography was evaluated on Diagnostic accuracy (sensitivity and accuracy) for detecting left ventricular hypertrophy. Electrocardiography voltage criteria performed poorly in detecting left ventricular hypertrophy compared to echocardiography, with extremely low sensitivities ranging from 1.9% to 19.2%.
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