Electrocardiogram Performance in the Diagnosis of Left Ventricular Hypertrophy in Hypertensive Patients With Left Bundle Branch Block

Abstract

BackgroundLeft ventricular hypertrophy (LVH) is an important risk factor for cardiovascular events, and its detection usually begins with an electrocardiogram (ECG).ObjectiveTo evaluate the impact of complete left bundle branch block (CLBBB) in hypertensive patients in the diagnostic performance of LVH by ECG.MethodsA total of 2,240 hypertensive patients were studied. All of them were submitted to an ECG and an echocardiogram (ECHO). We evaluated the most frequently used electrocardiographic criteria for LVH diagnosis: Cornell voltage, Cornell voltage product, Sokolow-Lyon voltage, Sokolow-Lyon product, RaVL, RaVL+SV3, RV6/RV5 ratio, strain pattern, left atrial enlargement, and QT interval. LVH identification pattern was the left ventricular mass index (LVMI) obtained by ECHO in all participants.ResultsMean age was 11.3 years ± 58.7 years, 684 (30.5%) were male and 1,556 (69.5%) were female. In patients without CLBBB, ECG sensitivity to the presence of LVH varied between 7.6 and 40.9%, and specificity varied between 70.2% and 99.2%. In participants with CLBBB, sensitivity to LVH varied between 11.9 and 95.2%, and specificity between 6.6 and 96.6%. Among the criteria with the best performance for LVH with CLBBB, Sokolow-Lyon, for a voltage of ≥ 3,0mV, stood out with a sensitivity of 22.2% (CI 95% 15.8 - 30.8) and specificity of 88.3% (CI 95% 77.8 - 94.2).ConclusionIn hypertensive patients with CLBBB, the most often used criteria for the detection of LVH with ECG showed significant decrease in performance with regards to sensitivity and specificity. In this scenario, Sokolow-Lyon criteria with voltage ≥3,0mV presented the best performance.

Assessment of Left Ventricular Hypertrophy (LVH) Criteria by Surface Electrocardiography in a Sample of Iraqi Patients with Systemic Arterial Hypertension

“…In a Chinese study, Su et al . ( 19 ) evaluated SPB in 1120 patients and found a highly significant association between it and LVMI. LVH was also associated using antihypertensive drug (OR=2.68, 95%CI=1.07-6.7, P=0.031).…”

Diagnostic value of the electrocardiographic criteria of left ventricular hypertrophy in arterial hypertension

“…En un estudio en adultos hipertensos realizado en Brasil se encontró una sensibilidad mayor y una especificidad similar a este estudio en pacientes con HVI moderada tanto en el criterio de (18) Cornell como Sokolow-Lyon . Otro estudio realizado en EEUU por Peguero y col. encontraron también una sensibilidad baja y una especificidad alta utilizando los criterios de Cornell y Sokolow- (19) Lyon en pacientes hipertensos .…”

“…Analizando cada uno de los resultados, se puede observar una tendencia de que a medida que aumentan las dimensiones del ventrículo izquierdo también aumenta la sensibilidad de los criterios, a excepción del criterio R6:R5. Las diferencias sustanciales entre los criterios y los resultados de (18)(19)(20)(21)(22) otros estudios podrían obedecer a causas multifactoriales no determinadas .…”

Comparison of the Performance of Three Commonly Used Electrocardiographic Indexes for the Diagnosis of Left Ventricular Hypertrophy in Black Hypertensive Patients with Reduced Kidney Function Managed at a Tertiary Healthcare Hospital: A Post-Hoc Analysis

“…LVHinduced conduction system abnormalities could also contribute to the observed better performance of Sokolow-Lyon index in the present post-hoc analysis. Indeed, Burgos et al [48] reported in hypertensive patients that among ECG criteria with the best performance for LVH and complete Left bundle branch block (CLBBB), Sokolow-Lyon index stood out with a better sensitivity and specificity.…”