Published online Mar 26, 2019. doi: 10.4330/wjc.v11.i3.94
Peer-review started: November 19, 2018
First decision: December 10, 2018
Revised: December 12, 2018
Accepted: December 24, 2018
Article in press: December 24, 2018
Published online: March 26, 2019
Processing time: 142 Days and 9 Hours
Left ventricular hypertrophy (LVH) is a common manifestation of cardiovascular disease and a risk factor for cardiovascular morbidity and mortality, but available methods for its electrocardiographic (ECG) diagnosis have limited accuracy.
To investigate findings associated with LVH on ECG and developed an improved system for the diagnosis of LVH.
A cohort study comparing ECG data acquired within 30 days of transthoracic echocardiography (TTE) was performed. Multivariate regression analysis identified ECG findings associated with increased LV mass and mass index. A scoring system was derived and performance compared to established criteria for LVH.
Data from 5486 outpatients with TTEs and corresponding ECGs were included in the derivation cohort, 333 (6.1%) of whom had LVH by TTE. In the primary regression analysis, findings associated with LVH were amplitudes of Q in V3, R in V6, S in V3, T in V6, P’ in V1, P in V6, as well as R and T-axis discordance, R peak time in V6, QRS duration, weight, height, sex, and age. From this we derived a score consisting of 5 criteria, and validated it in an independent cohort of 910 patients. With a threshold of 1.5 points, sensitivity and specificity were 67.9% and 81.4%, and 62.5% and 83.2% in the derivation and validation cohorts, respectively. With a threshold of 2 points, sensitivity and specificity were 42.3% and 93.0%, and 37.5% and 93.4% in these cohorts.
This score had superior sensitivity for detection of LVH by ECG while making a modest sacrifice in specificity compared to conventional criteria.
Core tip: In this study we performed analysis of a large number of echocardiograms with corresponding electrocardiographic (ECG), and though multivariate regression analysis identified ECG findings associated with left ventricular hypertrophy (LVH). Using these findings, a five-item scoring system was developed to diagnose LVH on ECG. The performance characteristics of the system were compared to several conventional criteria, and it was seen to have superior sensitivity, including in an independent validation cohort. Using this scoring system, we believe that the diagnosis of LVH on ECG will be more clinically applicable in certain patient populations given the enhanced sensitivity of this test.