How reliable is the electrocardiogram in detecting left ventricular hypertrophy in hypertension?

Vijan, S.G.; Manning, Gillian; Millar-Craig, Michael W

doi:10.1136/pgmj.67.789.646

Cited by 10 publications

(5 citation statements)

References 12 publications

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“…This was particularly evident for tests employing peripheral leads only, such as the Lewis index and the RaVL criterion: in fact it identified only 1/20 of LVH cases that were demonstrated using the echocar diogram. Similar findings, showing a limited ability of ECG in identifying the true positives, were previously reported [35]. For example, even in patients with an LVMI >200 g/m2, positive ECG criteria were reached in less than 20% of cases [36], and only in 40% of subjects whose hearts weighed more than 1 kg did the tallest limb lead R exceed 13 mm [ 13].…”

Section: Reliability O F Ecg Testssupporting

confidence: 70%

Left-Ventricular Hypertrophy in the Elderly: Unreliability of ECG Criteria in 477 Subjects Aged 65 Years or More

et al. 1996

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Aim: To evaluate the diagnostic reliability of the ECG diagnosis of left-ventricular hypertrophy (LVH) in a cohort of elderly subjects taken from a general population. Patients: The 447 subjects with perfect echocardiography and ECG results of the 2,254 included in the Cardiovascular Study in the Elderly. Methods: Sensitivity, specificity, positive and negative predictive value of the most commonly used ECG tests of LVH were calculated versus the gold standard, echocardiography. Results: All ECG tests had a very low sensitivity. Furthermore, except for the Cornell index and (at least in the normotensives) the Minnesota code, they were not able to demonstrate the higher prevalence of LVH in elderly females in comparison to males. The predictive value of ECG was constantly higher in males than females when negative; when positive, some tests were more predictive in males, some in females, and in others, equally predictive in both sexes. Conclusions: ECG is not a reliable method for screening LVH in elderly populations. Echocardiography and ECG give different information, and their reliability may be different if positive or negative.

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Section: Reliability O F Ecg Testssupporting

confidence: 70%

Left-Ventricular Hypertrophy in the Elderly: Unreliability of ECG Criteria in 477 Subjects Aged 65 Years or More

et al. 1996

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“…However, the ECG has been found to be specific but insensitive in the detection of LVH compared to echocardiography. 31 The findings from this study show that a small proportion of patients with white coat hypertension may have echocardiographic left ventricular hypertrophy (9%). In view of the implications of the presence of left ventricular hypertrophy, 32 echocardiography should be considered in patients with white coat hypertension to detect the presence or absence of left ventricular hypertrophy and thus target treatment at patients with documented target organ damage.…”

Section: Discussionmentioning

confidence: 64%

Clinical implications of white coat hypertension: an ambulatory blood pressure monitoring study

1999

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Within routine clinical practice, white coat hypertension (where blood pressure is persistently higher in the presence of the doctor or nurse but normal outside the medical setting) makes the diagnosis and management of hypertension difficult. There are conflicting data regarding the prevalence and significance of white coat hypertension. This study has used ambulatory blood pressure monitoring to detect the presence of white coat hypertension in 186 patients referred to an out-patient hypertension unit. The presence of white coat hypertension was defined as an average office blood pressure (measured on three occasions over a 2-month period) of >140/90 mm Hg and an ambulatory awake blood pressure < or = 136/86 mm Hg. The prevalence of white coat hypertension in those patients with borderline hypertension (diastolic blood pressure 90-99 mm Hg) and those with mild-to-moderate hypertension (diastolic blood pressure > or = 100 mm Hg) was determined. Echocardiography was used to assess left ventricular mass index in patients with and without white coat hypertension. The prevalence of white coat hypertension in the total group was 23%. However, the prevalence was higher (33%) in those patients with borderline hypertension compared to 9% of those patients with mild-to-moderate hypertension. There was a statistically significant increase in left ventricular mass index in patients with no evidence of white coat hypertension (125 gm/m2) compared to those with white coat hypertension (102 gm/m2). We conclude that, if office blood pressure is used to identify patients with hypertension who may require treatment, some patients will be incorrectly diagnosed and may be treated inappropriately. We recommend that ambulatory blood pressure monitoring is used in the routine assessment of all newly diagnosed hypertensive patients. Furthermore, we recommend echocardiography in patients with borderline hypertension as some will already have an increased left ventricular mass index.

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“…Large amount of research evidence indicates that sensitivity of traditional electrocardiographic criteria for LVH is relatively poor when compared with the reference standard for LVH assessment -echocardiography [28][29][30][31][32][33][34]. However, Verdecchia et al and Schillaci et al suggest that using the combination of three highly specific criteria: the Romhilt-Estes point score, left ventricular strain and Cornell criteria in a cumulative score can produce a rise in sensitivity without excessive deterioration of specificity [35,36].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of electrocardiographic left ventricular hypertrophy among patients with coronary artery disease and diabetes mellitus

Ostrowska

Bellwon²,

Koziński³

et al. 2016

Medical Research Journal

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Prevalence of electrocardiographic left ventricular hypertrophy among patients with coronary artery disease and diabetes mellitus ABSTRACT Introduction. Electrocardiography (ECG) is a widely used non-invasive diagnostic method for assessment of patients with cardiovascular diseases. Numerous different electrocardiographic criteria exist for detection of left ventricular hypertrophy (LVH). LVH is an important risk factor in patients with coronary artery disease (CAD) or diabetes mellitus and its presence is associated with increased cardiovascular morbidity and mortality. The aim of this study was to evaluate the prevalence of the most frequently used electrocardiographic left ventricular hypertrophy (ECG-LVH) criteria among patients with CAD and diabetes. Methods.A cross-sectional, multicenter study was conducted in outpatient clinics across Poland. Family physicians performed physical examinations and collected relevant information about: onset of CAD and diabetes, presence and onset of hypertension, dyslipidemia, heart failure, diabetic complications, history of acute coronary syndrome and pharmacotherapy. In order to detect LVH, we used seven ECG criteria: 1) the Sokolow-Lyon voltage, 2) the Gubner voltage, 3) the criterion of the R wave amplitude on the leads V5-V6 and 4) aVL, 5) the gender specific Cornell voltage and 6) product, and 7) the Romhilt-Estes point score. Centralized manual assessment of the obtained ECG tracings were performed.Results. We enrolled 1001 patients (48.5% women, 51.5% men, mean age 65 ± 11 years) into the study. At least one ECG-LVH criterion was met in 20.0% (n = 200) of the study participants. The ECG-LVH diagnosis was the most common when using the Romhilt-Estes point score (n = 138; 13.8%). The corresponding prevalence rates for the Cornell voltage, the Cornell product, the R wave amplitude on the lead aVL, the Sokolow-Lyon voltage, the Gubner voltage and the R wave amplitude on the leads V5-V6 criteria were 5.5% (n = 55), 5.2% (n = 52), 3.2% (n = 32), 2.2% (n = 22), 1.9% (n = 19) and 1.3% (n = 13) respectively. Subsequently, the prevalence of the three most frequently used in clinical practice electrocardiographic criteria for LVH (the Sokolow-Lyon voltage, the Cornell voltage and the Romhilt-Estes point score) was analyzed. At least one of them was fulfilled in 185 ECGs. All three criteria at the same time were met only in 5 ECGs (2.7% of 185). Two and only one out of three criteria were fulfilled in 20 (10.8%) and 160 (86.5%) ECGs respectively.Conclusions. The co-occurrence of all assessed ECG-LVH criteria, including the three most frequently applied in clinical practice, is very low in diabetic CAD patients. The Romhilt-Estes point score identifies the highest number of ECG-LVH cases in this setting. However, it seems reasonable to use routinely several ECG criteria for detection of LVH. Further studies are needed to compare diagnostic values of ECG-LVH criteria with imaging methods and to assess prognostic values of various ECG-LVH criteria.

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How reliable is the electrocardiogram in detecting left ventricular hypertrophy in hypertension?

Abstract: Summary:This

Cited by 10 publications

References 12 publications

Left-Ventricular Hypertrophy in the Elderly: Unreliability of ECG Criteria in 477 Subjects Aged 65 Years or More

Left-Ventricular Hypertrophy in the Elderly: Unreliability of ECG Criteria in 477 Subjects Aged 65 Years or More

Clinical implications of white coat hypertension: an ambulatory blood pressure monitoring study

Prevalence of electrocardiographic left ventricular hypertrophy among patients with coronary artery disease and diabetes mellitus

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