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Abiodun OO, Anya T, Adekanmbi VT. Electrocardiographic Abnormalities in Nigerian Hypertensives With Echocardiographic Left Ventricular Hypertrophy. Cureus 2024; 16:e60170. [PMID: 38868248 PMCID: PMC11167321 DOI: 10.7759/cureus.60170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/14/2024] Open
Abstract
Introduction To enhance the diagnosis of anatomic left ventricular hypertrophy (LVH) using electrocardiography (ECG), we aimed to identify common ECG amplitude and non-amplitude abnormalities in Nigerian patients with hypertensive echocardiographic LVH. Method The study included 1,765 patients with essential hypertension aged 18 years and older from the Federal Medical Centre Abuja Hypertension Registry (FMCAHR). Participants underwent echocardiography and ECG following the American College of Cardiology and the American Society of Echocardiography guidelines. Results The prevalence of overall ECG LVH amplitude criteria (43.8%) and individual criteria of Cornell voltage (27.1%), Sokolow-Lyon voltage (23.2%), and Gubner-Ungerleider (13.9%) were higher than non-amplitude ECG abnormalities among patients with echocardiographic LVH. The sensitivity and specificity of LVH criteria were 43.8% and 79.5% for overall ECG LVH, 23.2% and 87.2% for Sokolow-Lyon voltage, 27.1% and 93.3% for Cornell voltage, and 13.9% and 95.4% for Gubner-Ungerleider criteria, respectively. After multivariable adjustment, non-amplitude ECG changes, including prolonged corrected QT (QTc) (odds ratio (OR): 1.68, 95% confidence interval (CI): 1.06-2.66), left ventricular (LV) strain pattern (OR: 1.83, CI: 1.23-2.72), left axis deviation (OR: 1.56, CI: 1.09-2.24), poor R wave progression (OR: 2.36, CI: 1.40-3.97), premature ventricular contractions (OR: 1.80, CI: 1.10-2.91), premature atrial contractions (OR: 2.06, CI: 1.10-3.87), atrial fibrillation (OR: 2.40, CI: 1.20-4.82), and left atrial abnormality (OR: 8.43, CI: 2.95-24.05), were associated with echocardiographic LVH (p < 0.05). Conclusion In our cohort of hypertensive patients, ECG LVH amplitude criteria were the most frequently observed abnormalities associated with echocardiographic LVH. Our findings suggest that despite the low sensitivity, ECG LVH amplitude criteria may remain valuable in diagnosing echocardiographic LVH.
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Affiliation(s)
| | - Tina Anya
- Internal Medicine/Cardiology, Federal Medical Centre, Abuja, NGA
| | - Victor T Adekanmbi
- Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, USA
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Sakboonyarat B, Poovieng J, Rangsin R. Factors associated with electrocardiographic left ventricular hypertrophy among patients with hypertension in Thailand. Clin Hypertens 2024; 30:8. [PMID: 38556865 PMCID: PMC10983697 DOI: 10.1186/s40885-024-00267-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/27/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) strongly predicts cardiovascular diseases (CVD) and death. One-fourth of Thai adults suffer from hypertension. Nevertheless, the information on LVH among Thai patients with hypertension is not well characterized. We aimed to identify the prevalence and factors associated with electrocardiographic LVH (ECG-LVH) among patients with hypertension in Thailand. METHODS The present study obtained the dataset from the Thailand Diabetes Mellitus/Hypertension study, which included hypertension patients aged 20 years and older receiving continuous care at outpatient clinics in hospitals nationwide in 2011-2015 and 2018. Meanwhile, those without a record of 12-lead electrocardiography (ECG) were excluded from the analysis. ECG-LVH was defined as the LVH noted regarding ECG interpretation in the medical records. Multivariable logistic regression analysis was utilized for determining factors associated with ECG-LVH and presented as the adjusted odds ratio (AOR) and 95% confidence interval (CI). RESULTS From 226,420 hypertensive patients in the Thailand Diabetes Mellitus/Hypertension study, 38,807 individuals (17.1%) with ECG data recorded were included in the analysis. The mean age was 64.8 ± 11.5 years, and 62.2% were women. Overall, 1,557 study participants had ECG-LVH, with an estimated prevalence of 4.0% (95% CI, 3.8-4.2%). Age-adjusted ECG-LVH prevalence among women and men was 3.4 and 5.1%, respectively (P < 0.001). Multivariable analysis determined factors associated with ECG-LVH, including being men (AOR, 1.49; 95% CI, 1.31-1.69), individuals aged 70 to 79 years (AOR, 1.56; 95% CI, 1.20-2.02) and ≥ 80 years (AOR, 2.10; 95% CI, 1.58-2.78) compared to individuals aged less than 50 years, current smokers (AOR, 1.26; 95% CI, 1.09-1.46) compared to those who never smoked, systolic blood pressure ≥ 140 mmHg and diastolic blood pressure ≥ 90 mmHg (AOR, 1.58; 95% CI, 1.30-1.92) compared to systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg. CONCLUSIONS The current study illustrated the prevalence of ECG-LVH among Thai patients with hypertension who had ECG recorded and identified high-risk groups who tended to have ECG-LVH. The findings underscore the need for targeted interventions, particularly among high-risk groups such as older individuals, men, and current smokers, to address modifiable factors associated with ECG-LVH.
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Affiliation(s)
- Boonsub Sakboonyarat
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand.
| | - Jaturon Poovieng
- Pulmonary and Critical Care Division, Department of Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
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Faggiano A, Gherbesi E, Tadic M, Carugo S, Grassi G, Cuspidi C. Do We Need New Electrocardiographic Criteria for Left Ventricular Hypertrophy? The Case of the Peguero-Lo Presti Criterion. A Narrative Review. Am J Hypertens 2024; 37:155-162. [PMID: 38112655 PMCID: PMC10906064 DOI: 10.1093/ajh/hpad117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023] Open
Abstract
The cardiovascular risk associated with left ventricular hypertrophy (LVH) in the community and, particularly, in the hypertensive fraction of the general population, represents the rationale for its timely and accurate identification in order to implement adequate preventive strategies. Although electrocardiography (ECG) is the first-line and most economical method of diagnosing LVH its accuracy is largely suboptimal. Over the last 70 years, dozens of different ECG criteria, mostly based on measurements of QRS voltages, have been proposed. In this long journey, a few years ago Peguero et al. developed a novel ECG voltage criterion, currently recognized as Peguero-Lo Presti (PLP) suggesting that it has greater sensitivity than traditional ECG-LVH criteria. Considering that in the last 5 years numerous studies have investigated the diagnostic value of this new index, this review aimed to summarize the data published so far on this topic focusing both on the accuracy in identifying the presence of LVH compared with imaging techniques such as echocardiography (ECHO) and magnetic resonance imaging (MRI) and the value in predicting hard outcomes. The evidence in favor of the greater diagnostic accuracy of the PLP criterion in detecting LVH, phenotyped by ECHO or MRI, and in the stratification of hard outcomes compared with traditional ECG criteria does not appear to be sufficiently proven. Given that the diagnosis of LVH by all ECG criteria (including the PLP) exclusively based on the QRS amplitude is largely imprecise, the development of new multiparametric ECG criteria based on artificial intelligence could represent a real improvement in the diagnostic capacity of the ECG.
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Affiliation(s)
- Andrea Faggiano
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
| | - Elisa Gherbesi
- Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
| | - Marijana Tadic
- Department of Cardio-Thoracic-Vascular Diseases, University Heart Center Ulm, University Ulm, Ulm, Germany
| | - Stefano Carugo
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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Zhao X, Huang G, Wu L, Wang M, He X, Wang JR, Zhou B, Liu Y, Lin Y, Liu D, Yu X, Liang S, Tian B, Liu L, Chen Y, Qiu S, Xie X, Han L, Qian X. Deep learning assessment of left ventricular hypertrophy based on electrocardiogram. Front Cardiovasc Med 2022; 9:952089. [PMID: 36035939 PMCID: PMC9406285 DOI: 10.3389/fcvm.2022.952089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCurrent electrocardiogram (ECG) criteria of left ventricular hypertrophy (LVH) have low sensitivity. Deep learning (DL) techniques have been widely used to detect cardiac diseases due to its ability of automatic feature extraction of ECG. However, DL was rarely applied in LVH diagnosis. Our study aimed to construct a DL model for rapid and effective detection of LVH using 12-lead ECG.MethodsWe built a DL model based on convolutional neural network-long short-term memory (CNN-LSTM) to detect LVH using 12-lead ECG. The echocardiogram and ECG of 1,863 patients obtained within 1 week after hospital admission were analyzed. Patients were evenly allocated into 3 sets at 3:1:1 ratio: the training set (n = 1,120), the validation set (n = 371) and the test set 1 (n = 372). In addition, we recruited 453 hospitalized patients into the internal test set 2. Different DL model of each subgroup was developed according to gender and relative wall thickness (RWT).ResultsThe LVH was predicted by the CNN-LSTM model with an area under the curve (AUC) of 0.62 (sensitivity 68%, specificity 57%) in the test set 1, which outperformed Cornell voltage criteria (AUC: 0.57, sensitivity 48%, specificity 72%) and Sokolow-Lyon voltage (AUC: 0.51, sensitivity 14%, specificity 96%). In the internal test set 2, the CNN-LSTM model had a stable performance in predicting LVH with an AUC of 0.59 (sensitivity 65%, specificity 57%). In the subgroup analysis, the CNN-LSTM model predicted LVH by 12-lead ECG with an AUC of 0.66 (sensitivity 72%, specificity 60%) for male patients, which performed better than that for female patients (AUC: 0.59, sensitivity 50%, specificity 71%).ConclusionOur study established a CNN-LSTM model to diagnose LVH by 12-lead ECG with higher sensitivity than current ECG diagnostic criteria. This CNN-LSTM model may be a simple and effective screening tool of LVH.
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Affiliation(s)
- Xiaoli Zhao
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guifang Huang
- China Unicom (Guangdong) Industrial Internet Ltd., Guangzhou, China
| | - Lin Wu
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Min Wang
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuemin He
- Department of Endocrine and Metabolic Diseases, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jyun-Rong Wang
- LCFC (Hefei) Electronics Technology Co., Ltd., Hefei, China
- Hefei LCFC Information Technology Co., Ltd., Hefei, China
| | - Bin Zhou
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yong Liu
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yesheng Lin
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dinghui Liu
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xianguan Yu
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Suzhen Liang
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Borui Tian
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Linxiao Liu
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanming Chen
- Department of Endocrine and Metabolic Diseases, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shuhong Qiu
- China Unicom (Guangdong) Industrial Internet Ltd., Guangzhou, China
| | - Xujing Xie
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Xujing Xie
| | - Lanqing Han
- Center for Artificial Intelligence, Research Institute of Tsinghua, Pearl River Delta, Guangzhou, China
- Lanqing Han
| | - Xiaoxian Qian
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Xiaoxian Qian
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Marcato JP, Senra Santos F, Gama Palone A, Lenci Marques G. Evaluation of Different Criteria in the Diagnosis of Left Ventricular Hypertrophy by Electrocardiogram in Comparison With Echocardiogram. Cureus 2022; 14:e26376. [PMID: 35911263 PMCID: PMC9329598 DOI: 10.7759/cureus.26376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/11/2022] Open
Abstract
Left ventricular hypertrophy (LVH) is an adaptive mechanism of the cardiac muscle due to increased activity demand or functional overload. The echocardiogram (ECHO) presents a better performance in relation to the electrocardiogram (ECG) for the diagnosis of LVH. However, the ECG is a low-cost and easy-to-reproduce diagnostic alternative and can be useful in services and locations where the ECHO is not yet easily accessible. Recently, a new criterion for LVH was proposed by Peguero-Lo Presti. The aim of this article was to evaluate the electrocardiographic criteria for the diagnosis of LVH (Sokolow-Lyon, Cornell voltage, Romhilt-Estes, and Peguero-Lo Presti) in comparison to the diagnosis made by the ECHO. ECHO and ECG from 142 patients' medical records were analyzed. Patients were divided into three groups according to the ECHO - control, eccentric LVH, and concentric LVH. Sensitivity, specificity, PPV, NPV, and accuracy of the four electrocardiographic criteria were evaluated in three scenarios - (1) LVH vs control, (2) concentric LVH vs control, and (3) eccentric LVH vs control. Of the 142 patients included in the study, 100 (70.4%) had LVH. According to the type of hypertrophy, the 100 patients with LVH were divided into two groups - 41 (28.8%) had eccentric LVH and 59 (41.5%) had concentric LVH. Of all the scenarios, the Peguero-Lo Presti criteria obtained the best sensitivity (1, 41%; 2, 33,9%; 3, 51,2%) and accuracy (1, 56,3%; 2, 58,4%; 3, 69,8%). The Sokolow-Lyon criteria showed greater specificity in all analyses (100%). None of the electrocardiographic criteria obtained sensitivity values that would justify the use of the electrocardiogram as a screening test for LVH. No differences were found for eccentric and concentric LVH in terms of diagnosis using electrocardiographic criteria. We recommend the use of these criteria to confirm the diagnosis of LVH, especially in low-complexity services that do not have image-based diagnostic tests.
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Affiliation(s)
| | | | - André Gama Palone
- Cardiology, Heart Institute, Clinical Hospital, Faculty of Medicine, University of São Paulo, São Paulo, BRA
| | - Gustavo Lenci Marques
- Internal Medicine, Federal University of Paraná, Curitiba, BRA
- Medicine, Pontifical Catholic University of Paraná, Curitiba, BRA
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Boriani G, Valenti AC, Vitolo M. Clinical implications of assessing frailty in elderly patients treated with permanent cardiac pacing. J Cardiovasc Med (Hagerstown) 2022; 23:87-90. [PMID: 34958313 DOI: 10.2459/jcm.0000000000001220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
| | - Anna Chiara Valenti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
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Gamrat A, Trojanowicz K, Surdacki MA, Budkiewicz A, Wąsińska A, Wieczorek-Surdacka E, Surdacki A, Chyrchel B. Diagnostic Ability of Peguero-Lo Presti Electrocardiographic Left Ventricular Hypertrophy Criterion in Severe Aortic Stenosis. J Clin Med 2021; 10:jcm10132864. [PMID: 34203345 PMCID: PMC8268163 DOI: 10.3390/jcm10132864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/20/2021] [Accepted: 06/27/2021] [Indexed: 11/24/2022] Open
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.
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Affiliation(s)
- Aleksandra Gamrat
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (A.G.); (K.T.); (M.A.S.); (A.B.); (A.W.)
| | - Katarzyna Trojanowicz
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (A.G.); (K.T.); (M.A.S.); (A.B.); (A.W.)
| | - Michał A. Surdacki
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (A.G.); (K.T.); (M.A.S.); (A.B.); (A.W.)
| | - Aleksandra Budkiewicz
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (A.G.); (K.T.); (M.A.S.); (A.B.); (A.W.)
| | - Adrianna Wąsińska
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (A.G.); (K.T.); (M.A.S.); (A.B.); (A.W.)
| | - Ewa Wieczorek-Surdacka
- Chair and Department of Nephrology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland;
| | - Andrzej Surdacki
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland;
| | - Bernadeta Chyrchel
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland;
- Correspondence: ; Tel.: +48-12-400-2250
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Clinical applicability and diagnostic performance of electrocardiographic criteria for left ventricular hypertrophy diagnosis in older adults. Sci Rep 2021; 11:11516. [PMID: 34075174 PMCID: PMC8169892 DOI: 10.1038/s41598-021-91083-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/19/2021] [Indexed: 12/25/2022] Open
Abstract
Recently, a new ECG criterion, the Peguero-Lo Presti (PLP), improved overall accuracy in the diagnosis of left ventricular hypertrophy (LVH)—compared to traditional ECG criteria, but with few patients with advanced age. We analyzed patients with older age and examined which ECG criteria would have better overall performance. A total of 592 patients were included (83.1% with hypertension, mean age of 77.5 years) and the PLP criterion was compared against Cornell voltage (CV), Sokolow-Lyon voltage (SL) and Romhilt-Estes criteria (cutoffs of 4 and 5 points, RE4 and RE5, respectively) using LVH defined by the echocardiogram as the gold standard. The PLP had higher AUC than the CV, RE and SL (respectively, 0.70 vs 0.66 vs 0.64 vs 0.67), increased sensitivity compared with the SL, CV and RE5 (respectively, 51.9% [95% CI 45.4–58.3%] vs 28.2% [95% CI 22.6–34.4%], p < 0.0001; vs 35.3% [95% CI 29.2–41.7%], p < 0.0001; vs 44.4% [95% CI 38.0–50.9%], p = 0.042), highest F1 score (58.3%) and net benefit for most of the 20–60% threshold range in the decision curve analysis. Overall, despite the best diagnostic performance in older patients, the PLP criterion cannot rule out LVH consistently but can potentially be used to guide clinical decision for echocardiogram ordering in low-resource settings.
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9
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Bayram N, Akoğlu H, Sanri E, Karacabey S, Efeoğlu M, Onur O, Denizbasi A. Diagnostic Accuracy of the Electrocardiography Criteria for Left Ventricular Hypertrophy (Cornell Voltage Criteria, Sokolow-Lyon Index, Romhilt-Estes, and Peguero-Lo Presti Criteria) Compared to Transthoracic Echocardiography. Cureus 2021; 13:e13883. [PMID: 33868847 PMCID: PMC8043050 DOI: 10.7759/cureus.13883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective/Aim: We aimed to evaluate the diagnostic utility of the widely used left ventricular hypertrophy (LVH) electrocardiography (ECG) criteria (Cornell Voltage Criteria [CVC], Sokolow-Lyon Index [SLI], Romhilt-Estes [REC], and Peguero-Lo Presti [PLP] Criteria) compared with the left ventricular mass measured by echocardiography. Methods: In this prospective diagnostic accuracy study, we screened all consecutive adults (18 to 65 years) who presented to our academic emergency department (ED) with increased blood pressure (≥130/85 mmHg) between January 2016 and January 2017, and we enrolled a convenience sample of 165 patients in our study. The attending emergency physician managed all patients as per their primary complaint. The consulting cardiologist performed a transthoracic echocardiogram (TTE) of the patient and calculated the left ventricular mass (LVM) according to the American Society of Echocardiography (ASE) formula. After completing the patient recruitment phase, researchers evaluated all ECGs and calculated scores for SLI, CVC, REC, and PLP. We used contingency tables to calculate the diagnostic utility metrics of all ECG criteria. Results: The prevalence of LVH by TTE was 31.5%. CVC, SLI, REC, and PLP criteria correctly identified (true positive rate) abnormal LVM in only 3.9%, 1.9%, 9.6%, and 19.2% of the patients, respectively. CVC, SLI, REC score and PLP criteria performed poorly with extremely low sensitivities (3.9%, 1.9%, 10%, 19.2%) and poor accuracies (67.3%, 64.9%, 57.7%, 69.7%). Conclusion: ECG voltage criteria's clinical utility in estimating LVM and LVH is low, and it should not be used for this purpose.
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Affiliation(s)
- Nurseli Bayram
- Department of Emergency Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, TUR
| | - Haldun Akoğlu
- Department of Emergency Medicine, Marmara University School of Medicine, Istanbul, TUR
| | - Erkman Sanri
- Department of Emergency Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, TUR
| | - Sinan Karacabey
- Department of Emergency Medicine, Marmara University School of Medicine, Istanbul, TUR
| | - Melis Efeoğlu
- Department of Emergency Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, TUR
| | - Ozge Onur
- Department of Emergency Medicine, Marmara University School of Medicine, Istanbul, TUR
| | - Arzu Denizbasi
- Department of Emergency Medicine, Marmara University School of Medicine, Istanbul, TUR
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10
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Yu Z, Song J, Cheng L, Li S, Lu Q, Zhang Y, Lin X, Liu D. Peguero-Lo Presti criteria for the diagnosis of left ventricular hypertrophy: A systematic review and meta-analysis. PLoS One 2021; 16:e0246305. [PMID: 33513186 PMCID: PMC7846009 DOI: 10.1371/journal.pone.0246305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 01/15/2021] [Indexed: 11/22/2022] Open
Abstract
Background The Peguero-Lo Presti criteria are novel electrocardiographic (ECG) diagnostic criteria for the detection of left ventricular hypertrophy (LVH) and represent the sum of the amplitude of the deepest S wave in any lead with the S wave in lead V4 (SD+SV4). The diagnostic efficacy of the Peguero-Lo Presti criteria in LVH is still debatable. We aimed to test the sensitivity and specificity of the Peguero-Lo Presti criteria and compared them with those of the Cornell voltage index to assess their overall performance in LVH diagnosis. Methods Electronic databases (e.g., Medline, Web of Knowledge, Embase, and the Cochrane Library) were searched from their inception until May 18, 2020. Trials written in English that investigated the Peguero-Lo Presti criteria for detecting LVH were included. Data were independently extracted and analyzed by two investigators. Results A total of 51 records were screened, and 6 trials comprising 13,564 patients were finally included. A bivariate analysis showed that the sensitivity of the Peguero-Lo Presti criteria (0.52, 95% confidence interval (CI) 0.46–0.58) was higher than that of the Cornell voltage index (0.29, 95% CI 0.23–0.36) and Sokolow-Lyon criteria (0.24, 95% CI 0.21–0.27); the diagnostic accuracy of the Peguero-Lo Presti criteria (0.69, 95% CI 0.65–0.73) was also higher than that of the Cornell voltage index (0.67, 95% CI 0.62–0.71) and Sokolow-Lyon criteria (0.28, 95% CI 0.25–0.32); and the specificity of the Peguero-Lo Presti criteria (0.85, 95% CI 0.79–0.90) was similar to that of the Cornell voltage index (0.92, 95% CI 0.89–0.95) and Sokolow-Lyon criteria (0.94, 95%CI 0.88–0.97). Two trials (including 12,748 patients) were discharged because they included partly healthy subjects and accounted for substantial heterogeneity. Pooled analysis of the remaining 4 trials (including 816 patients) showed that the sensitivity of the Peguero-Lo Presti criteria (0.56, 95% CI 0.51–0.61) was also higher than that of the Cornell voltage index (0.36, 95% CI 0.31–0.42) and Sokolow-Lyon criteria (0.24, 95% CI 0.18–0.31); the diagnostic accuracy of the Peguero-Lo Presti criteria (0.84, 95% CI 0.80–0.87) was also higher than that of the Cornell voltage index (0.54, 95% CI 0.50–0.58) and Sokolow-Lyon criteria (0.38, 95% CI 0.34–0.42); and the specificity of the Peguero-Lo Presti criteria (0.90, 95% CI 0.87–0.92) was similar to that of the Cornell voltage index (0.93, 95% CI 0.88–0.96) and Sokolow-Lyon criteria (0.97, 95% CI 0.90–0.99). Both the likelihood ratio and posttest probability of the Peguero-Lo Presti criteria and Cornell voltage index were moderate. Conclusion Based on this systematic review and meta-analysis, the Peguero-Lo Presti criteria-based ECG diagnostic method for LVH has high sensitivity, specificity and diagnostic accuracy and should be applied in clinical practice settings.
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Affiliation(s)
- Zongying Yu
- Department of Electrocardiography, The No. 4 Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Jie Song
- Department of Electrocardiography, The No. 4 Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Li Cheng
- Department of Electrocardiography, The No. 4 Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Shasha Li
- Department of Cardiology, The No. 4 Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Qun Lu
- Department of Electrocardiography, The No. 4 Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Yafeng Zhang
- Department of Infection Management, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Xiaoci Lin
- Department of Internal Medicine, The First People's Hospital of Daishan, Zhejiang, China
| | - Dadong Liu
- Department of Critical Care Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, China
- * E-mail:
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Noubiap JJ, Agbaedeng TA, Nyaga UF, Nkoke C, Jingi AM. A meta-analytic evaluation of the diagnostic accuracy of the electrocardiographic Peguero-Lo Presti criterion for left ventricular hypertrophy. J Clin Hypertens (Greenwich) 2020; 22:1145-1153. [PMID: 32608577 DOI: 10.1111/jch.13923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/01/2020] [Accepted: 06/06/2020] [Indexed: 12/15/2022]
Abstract
Although electrocardiography (ECG) is a cost-effective and convenient tool for routine screening of left ventricular hypertrophy (LVH), its performance has been shown to be poor. The Peguero-Lo Presti, a novel voltage criterion, was found to be potentially better than the most commonly used criteria. We conducted a systematic review and meta-analysis of its diagnostic accuracy compared to Cornell and Sokolow-Lyon voltage criteria. Bibliographic databases were searched to identify relevant articles. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (ROC) curves were performed for comparison. Ten studies reporting data from 5984 individuals were included in the meta-analysis. Peguero-Lo Presti had the highest pooled sensitivity (43.0%, 95% confidence interval [CI]: 30.2-56.9) followed by Cornell (26.1%; 95% CI: 16.9-37.9) and Sokolow Lyon (22.0%; 95% CI: 14.1-32.7). However, Peguero-Lo Presti had the lesser pooled specificity (90.5%; 95% CI: 86.3-93.5) and Cornell the highest (94.9%; 95% CI: 90.3-97.3). The pooled DOR was 6.63 (95% CI: 3.95-11.13), 5.50 (95% CI: 3.64-8.30), and 2.94 (95% CI: 2.20-3.92) for Peguero-Lo Presti, Cornell, and Sokolow-Lyon, respectively. Peguero-Lo Presti had the best accuracy according to summary ROC curves, with an area under the curve of 0.827 compared to 0.715 for Cornell, and 0.623 for Sokolow-Lyon. In conclusion, according to this meta-analysis, Peguero-Lo Presti has a better diagnostic performance than Cornell and Sokolow-Lyon and might be more useful in routine clinical practice as a screening tool for LVH.
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Affiliation(s)
- Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Thomas A Agbaedeng
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Ulrich Flore Nyaga
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
| | - Clovis Nkoke
- Division of Cardiology, Buea Regional Hospital, Buea, Cameroon
| | - Ahmadou M Jingi
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
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Chlabicz M, Jamiołkowski J, Paniczko M, Sowa P, Szpakowicz M, Łapińska M, Jurczuk N, Kondraciuk M, Ptaszyńska-Kopczyńska K, Raczkowski A, Szpakowicz A, Kamiński KA. ECG Indices Poorly Predict Left Ventricular Hypertrophy and Are Applicable Only in Individuals With Low Cardiovascular Risk. J Clin Med 2020; 9:jcm9051364. [PMID: 32384681 PMCID: PMC7290685 DOI: 10.3390/jcm9051364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/24/2020] [Accepted: 05/04/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Left ventricular hypertrophy (LVH) is an important risk factor for cardiovascular events. The electrocardiography (ECG) has poor sensitivity, but it is commonly used to detect LVH. Aim: To evaluate the diagnostic efficacy of known ECG indicators to recognize LVH in subgroups with different cardiovascular risk levels. Methods: 676 volunteers were included. Results: We found that 10.2% of the analyzed population had LVH based on echocardiography. Individuals with LVH were older, had a higher body mass index, higher systolic blood pressure, lower heart rate, higher parameters of insulin resistance, higher cardiovascular risk, and android-type obesity. Variables that remained independently associated with LVH were QRS duration, left atrial volume index, troponin T, and hemoglobin A1c. The receiver operating characteristics (ROC) curve analysis of the Sokolow–Lyon index did not show a significant predictive ability to diagnose LVH in the whole study population including all cardiovascular risk classes. The ROC curves analysis of Cornell and Lewis indices showed a modest predictive ability to diagnose LVH in the general population and in a low cardiovascular class. Conclusions: There is a need for new, simple methods to diagnose LVH in the general population in order to properly evaluate cardiovascular risk and introduce optimal medical treatment of concomitant disease.
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Affiliation(s)
- Małgorzata Chlabicz
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.C.); (J.J.); (M.P.); (P.S.); (M.S.); (M.Ł.); (N.J.); (M.K.); (A.R.)
- Department of Invasive Cardiology, Teaching University Hospital of Bialystok, 15-276 Bialystok, Poland
| | - Jacek Jamiołkowski
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.C.); (J.J.); (M.P.); (P.S.); (M.S.); (M.Ł.); (N.J.); (M.K.); (A.R.)
| | - Marlena Paniczko
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.C.); (J.J.); (M.P.); (P.S.); (M.S.); (M.Ł.); (N.J.); (M.K.); (A.R.)
| | - Paweł Sowa
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.C.); (J.J.); (M.P.); (P.S.); (M.S.); (M.Ł.); (N.J.); (M.K.); (A.R.)
| | - Małgorzata Szpakowicz
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.C.); (J.J.); (M.P.); (P.S.); (M.S.); (M.Ł.); (N.J.); (M.K.); (A.R.)
| | - Magda Łapińska
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.C.); (J.J.); (M.P.); (P.S.); (M.S.); (M.Ł.); (N.J.); (M.K.); (A.R.)
| | - Natalia Jurczuk
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.C.); (J.J.); (M.P.); (P.S.); (M.S.); (M.Ł.); (N.J.); (M.K.); (A.R.)
| | - Marcin Kondraciuk
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.C.); (J.J.); (M.P.); (P.S.); (M.S.); (M.Ł.); (N.J.); (M.K.); (A.R.)
| | | | - Andrzej Raczkowski
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.C.); (J.J.); (M.P.); (P.S.); (M.S.); (M.Ł.); (N.J.); (M.K.); (A.R.)
| | - Anna Szpakowicz
- Department of Cardiology, Teaching University Hospital of Bialystok, 15-276 Bialystok, Poland; (K.P.-K.); (A.S.)
| | - Karol Adam Kamiński
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.C.); (J.J.); (M.P.); (P.S.); (M.S.); (M.Ł.); (N.J.); (M.K.); (A.R.)
- Department of Cardiology, Teaching University Hospital of Bialystok, 15-276 Bialystok, Poland; (K.P.-K.); (A.S.)
- Correspondence: ; Tel.: +48-856-865-371
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