A meta‐analytic evaluation of the diagnostic accuracy of the electrocardiographic Peguero‐Lo Presti criterion for left ventricular hypertrophy

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.

Accuracy of the novel Peguero Lo‐Presti criterion for electrocardiographic detection of left ventricular hypertrophy in a black African population

“…Indeed, in a recent systematic review and meta‐analysis, Peguero‐Lo Presti had a better pooled diagnostic performance based on ROC analysis, with an AUC of 0.83 compared to 0.72 and 0.62 for Cornell and Sokolow, respectively. 6 However, some other studies showed some discrepancies as our study does. In a Turkish population, Keskin et al found that although the Peguero‐Lo Presti criterion had higher sensitivity than the Cornell criterion (17.5% vs 9.7%), it had lower specificity (94.5% vs 98.2%) and slightly lower overall performance based on the AUC (0.64 vs 0.67).…”

“…Several studies have shown a superiority of the Peguero‐Lo Presti criterion over the Cornell and Sokolow‐Lyon criteria. Indeed, in a recent systematic review and meta‐analysis, Peguero‐Lo Presti had a better pooled diagnostic performance based on ROC analysis, with an AUC of 0.83 compared to 0.72 and 0.62 for Cornell and Sokolow, respectively 6 . However, some other studies showed some discrepancies as our study does.…”

“… 5 A recent systematic review and meta‐analysis showed that Peguero‐Lo Presti had a higher accuracy than Cornell and Sokolow‐Lyon criteria, propounding that it might be more appropriate for routine screening of LVH. 6 However, a large study from China that was not included in this meta‐analysis suggested that with improved cutoff values, Cornell could be better than Peguero‐Lo Presti. 7 …”

“…In 2017, Peguero, Lo Presti and colleagues proposed a novel and simple criterion (Peguero‐Lo Presti) for the electrocardiographic screening of LVH that performed better than Sokolow‐Lyon and Cornell in their validation cohort 5 . A recent systematic review and meta‐analysis showed that Peguero‐Lo Presti had a higher accuracy than Cornell and Sokolow‐Lyon criteria, propounding that it might be more appropriate for routine screening of LVH 6 . However, a large study from China that was not included in this meta‐analysis suggested that with improved cutoff values, Cornell could be better than Peguero‐Lo Presti 7 …”

Diagnostic Ability of Peguero-Lo Presti Electrocardiographic Left Ventricular Hypertrophy Criterion in Severe Aortic Stenosis

“…A novel ECG criterion for LVH, proposed by Peguero et al [11], was recently shown to be more sensitive than traditional ECG-LVH criteria in patients with arterial hypertension. To date, the ability of the novel criterion to discriminate patients with and without anatomic LVH have been estimated in various clinical settings, including cardiac patients and the general population, demonstrating generally rather modest (and, at best, moderate) superiority over the classical ECG-LVH criteria in some [12][13][14][15][16], but not all [17][18][19][20][21][22][23]. However, to the best of our knowledge, only one study was focused on patients with aortic stenosis [24], the most prevalent valvular heart disease.…”