Electrocardiographic diagnosis of the left ventricular hypertrophy in patients with left bundle branch block: Is it necessary to verify old criteria?

Baranowski, Rafał; Małek, Łukasz A.; Prokopowicz, Dominika; Śpiewak, Mateusz; Miśko, Jolanta

doi:10.5603/cj.2012.0110

Cited by 11 publications

(15 citation statements)

References 21 publications

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“…The identification of LVH in patients with CLBBB has been controversial: some studies have reported correlations between various ECG voltage criteria and CLBBB, while others have not been able to confirm these findings [14,16,17,24]. In the present study, none of the criteria were significantly correlated with LVH, and the area under the ROC curve was less than 0.6 in all cases.…”

Section: Discussioncontrasting

confidence: 43%

“…In the present study, none of the criteria were significantly correlated with LVH, and the area under the ROC curve was less than 0.6 in all cases. As in previous studies, we found that the evaluated criteria have reasonable specificity but low sensitivity [14], which could be explained, in part, by the fact that QRS voltage tends to decrease after the appearance of CLBBB in patients with LVH [9].…”

Section: Discussionmentioning

confidence: 51%

“…Although some studies have suggested that CLBBB may have a benign prognosis [7,8], most have indicated that CLBBB has poorer prognosis in comparison to normal intraventricular conduction and also compared to right bundle branch block, with a median survival of 5 years from the time of diagnosis [2,4,5,7,[9][10][11][12]. Furthermore, the electrocardiography (ECG) characteristics of CLBBB obscure the application of common criteria for the diagnosis of left ventricular hypertrophy (LVH), myocardial infarction (MI) in the chronic phase, and diseases that cause modifications on the ST-T segment, establishing a need for other studies to assess these heart diseases in the presence of CLBBB [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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Relationship between electrocardiographic characteristics of left bundle branch block and echocardiographic findings

et al. 2015

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Section: Discussioncontrasting

confidence: 43%

Section: Discussionmentioning

confidence: 51%

Section: Introductionmentioning

confidence: 99%

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Relationship between electrocardiographic characteristics of left bundle branch block and echocardiographic findings

et al. 2015

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“…While LBBB is generally a marker of advanced cardiac disease rendering further myocardial decline [1], low coronary artery disease prevalence may incur unnecessary invasive intervention and cost. Many automated EKG algorithms assign a diagnosis of LBBB to QRS > 120 ms, predominantly negative in V1 regardless of V6 morphology [2,3]. This may misidentify up to 1/3 of patients with prolonged conduction due to left ventricular hypertrophy (chronic hypertension or valvular disease) as having LBBB [2].…”

Section: Discussionmentioning

confidence: 99%

Left Bundle Branch Block Chest Pain Conundrum

Seetharam¹,

Cheema²,

Friedman³

et al. 2020

Case Reports in Cardiology

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Left bundle branch block is a pattern of altered ventricular depolarization and subsequently affects repolarization. These obscure patterns can affect the traditional ST segment shift criteria for the electrocardiographic detection of coronary insufficiency syndromes. Previously, patients with coronary ischemic pain and LBBB judged to be “new” (not previously documented) were considered to have ST elevation myocardial infarction (STEMI) warranting acute thrombolytic therapy. Current STEMI management favors emergent invasive angiography; however, recent data suggests the prevalence of coronary obstructive pathology may be as low as 50%. The application of more specific, less-sensitive Sgarbossa electrocardiographic criteria may reduce angiographic assessment in an otherwise high-risk population unlikely to tolerate further myocardial injury. We present a case that may facilitate a more nuanced EKG-based approach to distinguish those who may benefit from acute invasive angiography while reducing the frequency of unnecessary angiographic evaluation.

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“…It is known, however, that several factors interfere in the diagnostic precision of LVH, more specifically the presence of conduction disturbances, especially CLBBB, which notoriously imposes limitations in LVH diagnosis. 20-22 …”

Section: Discussionmentioning

confidence: 99%

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

Burgos

Filho

Costa

et al. 2016

Arquivos Brasileiros De Cardiologia

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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.

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Electrocardiographic diagnosis of the left ventricular hypertrophy in patients with left bundle branch block: Is it necessary to verify old criteria?

Cited by 11 publications

References 21 publications

Relationship between electrocardiographic characteristics of left bundle branch block and echocardiographic findings

Relationship between electrocardiographic characteristics of left bundle branch block and echocardiographic findings

Left Bundle Branch Block Chest Pain Conundrum

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

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