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Current diagnostic ECG criteria for left ventricular hypertrophy: is it time to change paradigm in the analysis of
Danilo Ricciardi1, Giampaolo Vetta1, Antonio Nenna1
1Heart Center, Università Campus Bio-Medico di Roma, Rome, Italy.
Insights
Current electrocardiogram (ECG) criteria for left ventricular hypertrophy (LVH) show low sensitivity. The Cornell voltage and Cornell product criteria demonstrated superior diagnostic performance compared to others for detecting LVH.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Electrocardiography
Background:
- Twelve-lead ECG is a primary tool for screening left ventricular hypertrophy (LVH).
- Existing ECG criteria for LVH may lack sensitivity and clinical utility in practice.
Purpose of the Study:
- To compare the clinical performance of established ECG criteria for LVH.
- To evaluate the diagnostic accuracy of various ECG criteria against echocardiography in a real-world setting.
Main Methods:
- Retrospective analysis of ECG and echocardiographic data from 2134 hospitalized patients.
- Manual measurement of wave amplitudes from ECG traces.
- Transthoracic echocardiography used as the gold standard for LVH assessment.
Main Results:
- LVH prevalence was 58% in the study population.
- Cornell voltage yielded the highest area under the ROC curve (0.678), outperforming other criteria.
- R5/R6 criterion offered the best sensitivity (60%), while 'Q or S aVR' provided the highest specificity (99.9%).
Conclusions:
- Current ECG criteria for LVH exhibit low sensitivity but acceptable specificity.
- Cornell voltage and Cornell product criteria showed more accurate diagnostic performance.
- A novel approach to ECG data analysis may be needed to address current limitations in LVH detection.
Background:
Twelve-lead ECG represents the most common diagnostic tool in clinical cardiology and allows an immediate screening of left ventricular hypertrophy (LVH), but current criteria might have poor clinical usefulness in everyday clinical practice due to lack of sensitivity.
Methods:
The current study aims to review and compare the clinical performance of known ECG criteria of LVH in a real-life setting; 2134 patients had ECG and echocardiographic exams performed during the same hospitalization. All traces were retrospectively analysed, and the amplitudes of the waves were manually measured. Transthoracic echocardiography was considered as the gold standard to assess LVH.
Results:
LVH had a prevalence of 58%. Considering the diagnostic performance of ECG criteria for LVH, the Cornell voltage carried the best area under the receiver operating characteristic curve (0.678), while RaVF (R wave in aVF lead) had the poorer result (0.440). The R5/R6 criterion had the best sensitivity (60%), but with the worst specificity (37.4%). The 'Q or S aVR' had the best specificity (99.9%) but lacks sensitivity (0.80%). The Peguero Lo Presti criterion had a sensitivity of 42.3% and a specificity of 75.8%. The Cornell voltage and the Cornell product had similar area under the receiver operating characteristic curve values which were found to be significantly greater compared with other criteria.
Conclusion:
Current ECG criteria of LVH have low sensitivity despite an acceptable specificity. Among these, Cornell voltage and Cornell product criteria were equally found to have a more accurate diagnostic performance compared with other criteria. To overcome the intrinsic limitations of the current ECG LVH criteria, a new paradigm in the analysis of electrocardiographic data might be necessary.
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