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

Abstract

Traditional electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH), introduced in the pre-echocardiographic era of diagnosis, have a relatively low sensitivity (usually not exceeding 25–40%) in detecting LVH. A novel Peguero-Lo Presti ECG-LVH criterion was recently shown to exhibit a higher sensitivity than the traditional ECG-LVH criteria in hypertension. Our aim was to test the diagnostic ability of the novel Peguero-Lo Presti ECG-LVH criterion in severe aortic stenosis. We retrospectively analyzed 12-lead ECG tracings and echocardiographic records from the index hospitalization of 50 patients with isolated severe aortic stenosis (mean age: 77 ± 10 years; 30 women and 20 men). Exclusion criteria included QRS > 120 ms, bundle branch blocks or left anterior fascicular block, a history of myocardial infarction, more than mild aortic or mitral regurgitation, and significant LV dysfunction by echocardiography. We compared the agreement of the novel Peguero-Lo Presti criterion and traditional ECG-LVH criteria with echocardiographic LVH (LV mass index > 95 g/m2 in women and >115 g/m2 in men). Echocardiographic LVH was found in 32 out of 50 study patients. The sensitivity of the Peguero-Lo Presti criterion in detecting LVH was improved (55% vs. 9–34%) at lower specificity (72% vs. 78–100%) in comparison to 8 single traditional ECG-LVH criteria. Additionally, the positive predictive value (77% vs. 72%), positive likelihood ratio (2.0 vs. 1.5), and odds ratio (3.2 vs. 2.4) were higher for the Peguero-Lo Presti criterion versus the presence of any of these 8 traditional ECG-LVH criteria. Cohen’s Kappa, a measure of concordance between ECG and echocardiography with regard to LVH, was 0.24 for the Peguero-Lo Presti criterion, −0.01–0.13 for single traditional criteria, and 0.20 for any traditional criterion. However, by the receiver operating characteristics (ROC) curve analysis, the overall ability to discriminate between patients with and without LVH was insignificantly lower for the Peguero-Lo Presti versus Cornell voltage as a continuous variable (area under the ROC curve: 0.65 (95% CI, 0.48–0.81) vs. 0.71 (0.55–0.86), p = 0.5). In conclusion, our preliminary results suggest a slightly better, albeit still low, agreement of the novel Peguero-Lo Presti ECG criterion compared to the traditional ECG-LVH criteria with echocardiographic LVH in severe aortic stenosis.

Performance of the Peguero-Lo Presti Index in Diagnosis of Left Ventricular Hypertrophy at CIMAK Hospital Center in North Kivu, Democratic Republic of the Congo

“…The ROC curve showed that the Peguero-Lo Presti index had an AUC of 0.80, indicating its good overall performance compared to Skolow-Lyon (0.73) and Cornell (0.66). The results of this study are consistent with those of Gamrat et al which showed that the Peguero-Lo Presti index had improved sensitivity and specificity compared to the Sokolow-Lyon and Cornell-Voltage sensitivity (55% versus 9% at 34%) and specificity (78% versus 71% at 70%) in the diagnosis of LVH [21]. When screening for LVH in patients with cardiovascular disease, routine use of the Peguero-Lo Presti index should be considered [22] concluded by these authors.…”

Performance of the Newly Proposed Peguero-Lo Presti Criterion in Adults with Hypertrophic Cardiomyopathy

“…Therefore, the overall diagnostic accuracy of the Peguero-Lo Presti criterion is reliable for HCM. Recently, Gamrat et al [26] applied the Peguero-Lo Presti criterion to detect LVH in patients with severe aortic stenosis. The results showed that the Peguero-Lo Presti criterion had improved sensitivity (55% vs. 9%-34%) and decreased specificity (72% vs. 78%-100%) for the detection of LVH compared with 8 single traditional ECG criteria.…”

“…The results showed that the Peguero-Lo Presti criterion had improved sensitivity (55% vs. 9%–34%) and decreased specificity (72% vs. 78%–100%) for the detection of LVH compared with 8 single traditional ECG criteria. Compared with the traditional ECG-LVH criteria, the agreement between Peguero-Lo Presti criterion and echocardiographic LVH in patients with severe aortic stenosis was slightly better [ 26 ]. Matusik et al .…”

Effects of arteriovenous fistulas and central venous catheters on the cardiac function and prognosis of patients on maintenance hemodialysis

“…The criteria for left ventricular hypertrophy were as follows: a left ventricular mass index > 125 g/m 2 for men and >120 g/m 2 for women. 12 Left ventricular systolic dysfunction was defined as an ejection fraction (EF) <50.0%, 13 and a left ventricular diastolic dysfunction as an E/A <1.0. 14 In addition, the number of hospitalizations of the individuals in the two groups in one year were counted, and the distribution of causes (bleeding, infection and embolism) was analyzed.…”