Diagnostic Ability of Peguero-Lo Presti Electrocardiographic Left Ventricular Hypertrophy Criterion in Severe Aortic Stenosis.

Aleksandra Gamrat,Aleksandra Budkiewicz,Michał A Surdacki,Katarzyna Trojanowicz,Andrzej Surdacki,Ewa Wieczorek-Surdacka,Adrianna Wąsińska,Bernadeta Chyrchel

doi:10.3390/jcm10132864

Aleksandra Gamrat, Aleksandra Budkiewicz + Show 6 more

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https://doi.org/10.3390/jcm10132864

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Abstract

Traditional electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH), introduced in the pre-echocardiographic era of diagnosis, have a relatively low sensitivity (usually not exceeding 25–40%) in detecting LVH. A novel Peguero-Lo Presti ECG-LVH criterion was recently shown to exhibit a higher sensitivity than the traditional ECG-LVH criteria in hypertension. Our aim was to test the diagnostic ability of the novel Peguero-Lo Presti ECG-LVH criterion in severe aortic stenosis. We retrospectively analyzed 12-lead ECG tracings and echocardiographic records from the index hospitalization of 50 patients with isolated severe aortic stenosis (mean age: 77 ± 10 years; 30 women and 20 men). Exclusion criteria included QRS > 120 ms, bundle branch blocks or left anterior fascicular block, a history of myocardial infarction, more than mild aortic or mitral regurgitation, and significant LV dysfunction by echocardiography. We compared the agreement of the novel Peguero-Lo Presti criterion and traditional ECG-LVH criteria with echocardiographic LVH (LV mass index > 95 g/m2 in women and >115 g/m2 in men). Echocardiographic LVH was found in 32 out of 50 study patients. The sensitivity of the Peguero-Lo Presti criterion in detecting LVH was improved (55% vs. 9–34%) at lower specificity (72% vs. 78–100%) in comparison to 8 single traditional ECG-LVH criteria. Additionally, the positive predictive value (77% vs. 72%), positive likelihood ratio (2.0 vs. 1.5), and odds ratio (3.2 vs. 2.4) were higher for the Peguero-Lo Presti criterion versus the presence of any of these 8 traditional ECG-LVH criteria. Cohen’s Kappa, a measure of concordance between ECG and echocardiography with regard to LVH, was 0.24 for the Peguero-Lo Presti criterion, −0.01–0.13 for single traditional criteria, and 0.20 for any traditional criterion. However, by the receiver operating characteristics (ROC) curve analysis, the overall ability to discriminate between patients with and without LVH was insignificantly lower for the Peguero-Lo Presti versus Cornell voltage as a continuous variable (area under the ROC curve: 0.65 (95% CI, 0.48–0.81) vs. 0.71 (0.55–0.86), p = 0.5). In conclusion, our preliminary results suggest a slightly better, albeit still low, agreement of the novel Peguero-Lo Presti ECG criterion compared to the traditional ECG-LVH criteria with echocardiographic LVH in severe aortic stenosis.

Highlights

Left ventricular hypertrophy (LVH), defined as increased left ventricular mass, has long been recognized as a predictor of adverse clinical events, including death from cardiovascular causes [1,2,3,4]
In the pre-echocardiographic era, traditional ECG criteria were the only practical technique in the diagnosis of LVH [5]. Their drawback is a low sensitivity, generally not exceeding 30–40%, in detecting LVH diagnosed by magnetic resonance or echocardiography, the current standards in LVH diagnosis [5,6], ECG is still used as a screening tool owing to its wide availability
Our aim was to compare the concordance of the novel Peguero-Lo Presti LVH criterion and traditional ECG-LVH criteria with echocardiographic LVH in severe aortic stenosis

Summary

Introduction

Left ventricular hypertrophy (LVH), defined as increased left ventricular mass, has long been recognized as a predictor of adverse clinical events, including death from cardiovascular causes [1,2,3,4]. A novel ECG criterion for LVH, proposed by Peguero et al [11], was recently shown to be more sensitive than traditional ECG-LVH criteria in patients with arterial hypertension. The ability of the novel criterion to discriminate patients with and without anatomic LVH have been estimated in various clinical settings, including cardiac patients and the general population, demonstrating generally rather modest (and, at best, moderate) superiority over the classical ECG-LVH criteria in some [12,13,14,15,16], but not all [17,18,19,20,21,22,23]. In that report the Peguero-Lo Presti criterion had higher sensitivity than Cornell and Sokolow–Lyon LVH voltage criteria to predict anatomic LVH, a complex analysis of the agreement between the novel criterion, traditional ECG-LVH criteria, and anatomic LVH in aortic stenosis has not been reported so far

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