Diagnostic Performance of Electrocardiographic Criteria Compared With Echocardiographic Diagnosis of Left Ventricular Hypertrophy in Patients at the Outpatient Department

Abstract

INTRODUCTION: Several electrocardiographic (ECG) criteria have previously been suggested to diagnose left ventricular hypertrophy (LVH). Studies on diagnostic performance of each criterion in Asian population were limited and this study was done to determine the diagnostic performance of the six different ECG criteria, including the newly developed Peguero–Lo Presti criterion, in diagnosing LVH in Filipino patients. METHODOLOGY: A single-center retrospective cohort study was conducted. The comparison of ECG to echocardiographic diagnosis of LVH was assessed by Spearman ρ correlation. The area under the curve analysis was used to evaluate discrimination ability of ECG-LVH criteria to identify echocardiography-LVH. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the six criteria were described with 95% confidence interval, with P < 0.05 considered statistically significant. RESULTS: A total of 325 patients were included in the final analysis; 56.61% had LVH, 23.07% of which were both ECG-based and echocardiography-based LVH. The Peguero–Lo Presti criterion had the highest sensitivity (53.1%), a lower specificity (75.5%), and a lower accuracy (68.6%), compared with the other criteria. Sokolow-Lyon index had highest specificity (97.2%) and positive predictive value (75.0%). Cornell voltage had relatively better discriminative performance (area under the curve, 0.73). CONCLUSION: Having a higher sensitivity, the Peguero–Lo Presti criterion can be used as a screening tool for LVH more than the Sokolow-Lyon and Cornell voltage. Cornell voltage criterion has higher correlation with left ventricular mass index and better discriminative ability for the detection of LVH. Further studies with the possibility of combining different ECG criteria are suggested to increase the sensitivity of the ECG criteria. KEYWORDS: Cornell voltage, electrocardiographic LVH criteria, left ventricular mass index, Peguero–Lo Presti criteria, Sokolow-Lyon voltage