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Assessment of left ventricular hypertrophy in patients with essential hypertension. A rational basis for the
P V Fragola1, F Colivicchi, E Fabrizi
1Department of Internal Medicine, School of Cardiovascular Diseases, II University of Rome, Italy.
Insights
The electrocardiogram (ECG) shows low sensitivity but high specificity for detecting left ventricular hypertrophy (LVH) in hypertensive patients. Despite limitations, ECG may help identify hypertensive individuals with higher degrees of LVH for further assessment.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Electrocardiogram (ECG) is known for low sensitivity but high specificity in detecting left ventricular hypertrophy (LVH).
- Echocardiography is the standard for comparison in assessing LVH.
Purpose of the Study:
- To analyze ECG performance in detecting LVH in hypertensive patients.
- To test if ECG can identify hypertensive subsets with higher LVH degrees.
Main Methods:
- Studied 200 hypertensive patients (124 men, 76 women, mean age 50.9).
- Used echocardiography to determine left ventricular mass (LVM) as the gold standard.
- Compared ECG findings with echocardiographic LVH (LVM index > 125 g/m2 for men, 112 g/m2 for women).
Main Results:
- 34.5% of patients had echocardiographic LVH.
- Most ECG criteria showed high specificity (> 89%).
- The Lewis index demonstrated slightly superior sensitivity (43%) but no significant difference compared to other criteria at matched high specificities.
Conclusions:
- ECG has high specificity but limited sensitivity for LVH in hypertension.
- ECG may assist in identifying hypertensive patients likely to have significant LVH.
- Further research is needed to optimize ECG's role in LVH screening.
Abstract:
There is a large body of evidence that the electrocardiogram (ECG) is insensitive in the recognition of left ventricular hypertrophy (LVH), in comparison with the echocardiogram; however, its specificity is high. In this study we further analyzed the performance of the ECG in detecting LVH in 200 consecutive patients (124 men and 76 women, mean age 50.9 years) with mild to moderate essential hypertension, using echocardiographically determined left ventricular mass (LVM) as the standard for comparison. To test the hypothesis that, owing to the high number of true positive findings, the ECG may still be useful for clinical purposes by selecting subsets of hypertensives with higher degrees of LVH, we compared the mean values of LVM index corresponding to either positive (true positive) or negative (false negative) electrocardiographic signs of LVH. In this study 69 patients (34.5%) had echocardiographic LVH, as defined by a LVM index exceeding 125 g/m2 for men and 112 g/m2 for women. Almost all criteria demonstrated high levels of specificity (> or = 89%). In the whole group the Lewis index ((RI - RIII)+(SIII - SI) > or = 17 mm) showed a slight superiority in diagnosing LVH (sensitivity = 43%) in comparison to the remaining criteria; the confidence intervals estimate of sensitivities confirmed such diagnostic superiority only with respect to those criteria with a sensitivity < or = 17%. However, the use of McNemar's test to compare sensitivities of all electrocardiographic criteria at matched specificities (> or = 95%) did not show significant differences (P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)