Current diagnostic ECG criteria for left ventricular hypertrophy: is it time to change paradigm in the analysis of data?

Abstract

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.

Diagnostic Ability of Peguero-Lo Presti Electrocardiographic Left Ventricular Hypertrophy Criterion in Severe Aortic Stenosis

“…A novel ECG criterion for LVH, proposed by Peguero et al [11], was recently shown to be more sensitive than traditional ECG-LVH criteria in patients with arterial hypertension. To date, the ability of the novel criterion to discriminate patients with and without anatomic LVH have been estimated in various clinical settings, including cardiac patients and the general population, demonstrating generally rather modest (and, at best, moderate) superiority over the classical ECG-LVH criteria in some [12][13][14][15][16], but not all [17][18][19][20][21][22][23]. However, to the best of our knowledge, only one study was focused on patients with aortic stenosis [24], the most prevalent valvular heart disease.…”

Electrocardiographic Abnormalities in Nigerian Hypertensives With Echocardiographic Left Ventricular Hypertrophy

“…In this hypertensive cohort, the Cornell voltage criterion showed the highest area under the ROC curve (0.60), outperforming GU and SKL voltage criteria. Similarly, Ricciardi et al demonstrated that the Cornell voltage criterion had superior diagnostic performance compared to RaVF amplitude and the Peguero-Lo Presti criterion [ 21 ]. Likewise, Park et al found Cornell voltage to have better performance over the SKL voltage criterion in their study of 332 Koreans [ 22 ].…”

ECG Indices Poorly Predict Left Ventricular Hypertrophy and Are Applicable Only in Individuals with Low Cardiovascular Risk

“…We have shown that the Sokolow-Lyon voltage criteria for recognition of LVH were the weakest, which is in line with other studies. Elffers et al [31] showed that discriminative performance of the Sokolow-Lyon voltage criteria is poor (AUC: 0.58) in obese individuals, while Ricciardi et al [62] showed that the Cornel voltage and Cornel product criteria have a more accurate diagnostic performance compared with other hospitalized patients. Courad et al [63] suggested that the R wave in a VL lead should be the first index used to detect LVH of hypertensive patients, and it should replace the Sokolow-Lyon index due to the latter's inadequacies.…”