Comparison of Araoye's criteria with standard electrocardiographic criteria for diagnosis of left ventricular hypertrophy in Nigerian hypertensives

Abstract

Left ventricular hypertrophy (LVH) is a major risk factor for cardiovascular morbidity and mortality. Various electrocardiographic (ECG) criteria for LHV give poorer performance in black subjects when compared with white subjects. Araoye proposed a code system for improved ECG diagnosis of LVH in blacks. The Araoye's criteria are yet to be validated in black subjects. Electrocardiograms and echocardiograms were obtained from 100 hypertensive subjects and 60 controls. ECG LVH was determined by the Araoye's code criteria, Sokolow-Lyon; Cornell voltage; and Romhilt-Estes point score. Echocardiographic LVH was defined by LV mass indexed for height at 97.5 percentile of the controls (126 g.m(-1) and 130 g.m(-1) in females and males respectively). The prevalence of echocardiographic LVH indexed for height was 34% and 1.67% in the hypertensive and controls respectively while the prevalence of electrocardiographic LVH among the hypertensives were 18% by Romhilt Estes score, 48% by Sokolow-Lyon's criteria, 22% by Cornell's criteria and 51% by Araoye's criteria. The sensitivity and specificity respectively of the various electrocardiographic criteria were 65.7% and 76.8% for Sokolow-Lyon, 25.7% and 88.8% for Cornell's criteria 25.7% and 92.8% for Romhilt-Estes score and 71.4% and 74.4% for Araoye's criteria. Araoye's criteria did not differ significantly from Sokolow-Lyon criteria in identifying LVH but differed significantly from Cornell and Romhilt-Estes criteria. The number of positive codes in Araoye's criteria was significantly associated with the blood pressures, LV dimensions, and LV mass. The Araoye's code system for electrocardiographic diagnosis of LVH offer no comparative advantage over Sokolow-Lyon's criteria. However, the number of positive codes in Araoye's criteria identifies those individuals with more severe LVH.