Clinical applicability and diagnostic performance of electrocardiographic criteria for left ventricular hypertrophy diagnosis in older adults

Abstract

Recently, a new ECG criterion, the Peguero-Lo Presti (PLP), improved overall accuracy in the diagnosis of left ventricular hypertrophy (LVH)—compared to traditional ECG criteria, but with few patients with advanced age. We analyzed patients with older age and examined which ECG criteria would have better overall performance. A total of 592 patients were included (83.1% with hypertension, mean age of 77.5 years) and the PLP criterion was compared against Cornell voltage (CV), Sokolow-Lyon voltage (SL) and Romhilt-Estes criteria (cutoffs of 4 and 5 points, RE4 and RE5, respectively) using LVH defined by the echocardiogram as the gold standard. The PLP had higher AUC than the CV, RE and SL (respectively, 0.70 vs 0.66 vs 0.64 vs 0.67), increased sensitivity compared with the SL, CV and RE5 (respectively, 51.9% [95% CI 45.4–58.3%] vs 28.2% [95% CI 22.6–34.4%], p < 0.0001; vs 35.3% [95% CI 29.2–41.7%], p < 0.0001; vs 44.4% [95% CI 38.0–50.9%], p = 0.042), highest F1 score (58.3%) and net benefit for most of the 20–60% threshold range in the decision curve analysis. Overall, despite the best diagnostic performance in older patients, the PLP criterion cannot rule out LVH consistently but can potentially be used to guide clinical decision for echocardiogram ordering in low-resource settings.

Evaluation of Different Criteria in the Diagnosis of Left Ventricular Hypertrophy by Electrocardiogram in Comparison With Echocardiogram

“…Furthermore, in the literature, the comparison between the ECG and the ECHO is a common methodology for the evaluation of electrocardiographic criteria in the diagnosis of LVH. Since the publication of the Peguero-Lo Presti criterion, several studies have been carried out in this way in order to evaluate its performance, including a meta-analysis, whose results were similar to those found in our work [ 19 - 27 ].…”

“…In the study by Tavares et al, which included 592 patients aged over 70 years, the sensitivity of the Peguero-Lo Presti criterion was 51.9% [ 19 ]. Regarding specificity, this criterion obtained a performance of 82.1%.…”

“…ECG is an examination that analyzes the cardiac electrical activity, unlike the ECHO which evaluates the cardiac mass. However, we understand that the ECG can be useful in services and locations where the echocardiogram is not yet easily accessible, serving as a useful tool for the diagnosis and follow-up of LVH, as well as for optimizing the use of more complex tests in a health system [ 19 ]. In order to reduce the limitation resulting from the different nature of the examinations, we chose not to include patients in which this factor could cause more discrepancies and alterations, as in the case of heart deposition diseases.…”

Diretriz da Sociedade Brasileira de Cardiologia sobre a Análise e Emissão de Laudos Eletrocardiográficos – 2022

“…Associação dos critérios SAE e SAD. [58][59][60][61][62][63][64][65][66][67][68] Apesar do ecocardiograma apresentar elevada acurácia na identificação da SVE, o ECG, quando alterado, tem importante significado prognóstico. Dentre os critérios existentes, temos:…”

“…58 Quando a soma da amplitude da onda R na derivação aVL, com a amplitude da onda S de V3 for >28 mm em homens e 20 mm em mulheres. 67,68 Este critério é considerado positivo quando a soma da amplitude da maior onda S das 12 derivações com a onda S de V4 é ≥ 28 mm em homens e ≥ 23 mm em mulheres.…”