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Electrocardiogram Performance in the Diagnosis of Left Ventricular Hypertrophy in Hypertensive Patients With Left

Paula Freitas Martins Burgos1, Bráulio Luna Filho1, Francisco de Assis Costa1

  • 1Universidade Federal de São Paulo, Brazil.

Arquivos Brasileiros De Cardiologia
|December 20, 2016
PubMed

Insights

Complete left bundle branch block (CLBBB) significantly impairs electrocardiogram (ECG) detection of left ventricular hypertrophy (LVH) in hypertensive patients. The Sokolow-Lyon criteria showed the best performance in this challenging scenario.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Electrocardiography

Background:

  • Left ventricular hypertrophy (LVH) is a significant risk factor for cardiovascular events.
  • Electrocardiogram (ECG) is the initial diagnostic tool for LVH detection.

Purpose of the Study:

  • To assess the impact of complete left bundle branch block (CLBBB) on the diagnostic performance of ECG criteria for LVH in hypertensive patients.
  • To identify the most effective ECG criteria for LVH detection in the presence of CLBBB.

Main Methods:

  • A study involving 2,240 hypertensive patients who underwent both ECG and echocardiogram (ECHO).
  • Evaluation of multiple standard ECG criteria for LVH, including Cornell voltage, Sokolow-Lyon, and others.
  • Left ventricular mass index (LVMI) from ECHO served as the gold standard for LVH identification.

Main Results:

  • In patients without CLBBB, ECG sensitivity for LVH ranged from 7.6% to 40.9%, with specificity from 70.2% to 99.2%.
  • In patients with CLBBB, ECG sensitivity for LVH ranged from 11.9% to 95.2%, and specificity from 6.6% to 96.6%.
  • The Sokolow-Lyon criteria (voltage ≥ 3.0mV) demonstrated the best performance in patients with CLBBB, showing 22.2% sensitivity and 88.3% specificity.

Conclusions:

  • Standard ECG criteria for LVH detection exhibit reduced sensitivity and specificity in hypertensive patients with CLBBB.
  • The Sokolow-Lyon criteria (voltage ≥ 3.0mV) is the most reliable ECG method for diagnosing LVH in hypertensive patients with CLBBB.
Abstract

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