Abstract
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.
Highlights
Left ventricular hypertrophy (LVH) is a compensatory mechanism, which is induced by the heart to compensate for the high arterial blood pressure (BP), and it is an early finding of hypertension (HTN)
The classical paradigm of ECG diagnosis of LVH is based on the empirical finding of increased QRS voltage in cases of LVH, and a continuous effort is devoted to finding ECG criteria that agree best with LVH classification according to an ECG-independent standard such as transthoracic echocardiographic (TTE) LVH based on increased left ventricular mass (LVM)
We assessed the clinical utility of four established ECG voltage criteria to estimate LVH in patients presented to the triage of an emergency department (ED) with elevated BP
Summary
Left ventricular hypertrophy (LVH) is a compensatory mechanism, which is induced by the heart to compensate for the high arterial blood pressure (BP), and it is an early finding of hypertension (HTN). The most frequently used ECG voltage criteria to estimate LVH are classical Sokolow-Lyon Index (SLI) and Cornell Voltage Criteria (CVC), and more recent Romhilt-Estes Criteria (REC) score and Peguero-Lo Presti Criteria [9,10,11,12]. Despite their widespread acceptance and routine use in the clinical practice, the diagnostic accuracies of those criteria are low, especially with low sensitivity to rule-out and the presence of abnormally increased left ventricular mass (LVM) [12,13,14]. Recent guidelines suggested using LVM measured by 3D TTE (linear method) as an accurate method for estimating the degree of LVM anomaly that can precisely assess only by cardiac Magnetic Resonance
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
