Comparison of Various ECG Criteria in the Diagnosis of Left Ventricular Hypertrophy Using Echocardiography as Gold Standard

Abstract

A BS T R A C T BACKGROUNDLeft ventricular hypertrophy (LVH) is a progressive structural change characterized by thickening of left ventricular wall with or without enlargement. We wanted to evaluate different electrocardiography (ECG) criteria for the assessment of left ventricular hypertrophy (LVH) using echocardiography as gold standard. METHODSA total of 102 patients with hypertension were included in the study. Presence of LVH was assessed by Sokolow-Lyon criteria (SLC), Cornell Voltage criteria (CVC), and Romhilt -Estes Point Score (REPSS). Echocardiography was used to calculate the left ventricular mass index (LVMI) for the subjects. The sensitivity, specificity, accuracy, positive and negative predictive values of the three criteria were determined using LVMI calculated by Echo. RESULTSThe study included 80 (78.4%) males and 22 (21.6%) females, aged between 30 and 80 years. LVH by echocardiography was present in 69 (86%) males and 16 (72%) females. The sensitivity and specificity of the ECG criteria for LVH in males were 57% and 33% (SLC), 40% and 67% (CVC) and 37% and 58% (REPSS) respectively. Sensitivity and specificity of the ECG criteria in females were 65% and 60% (SLC), 60% and 100% (CVC) and 20% and 100% (REPSS) respectively. CONCLUSIONSNone of the 3 ECG criteria namely Sokolow-Lyon, Cornell Voltage, and Romhilt -Estes Point Score criteria could qualify as the initial screening test for LVH in a predominantly male hypertensive population. The Sokolow-Lyon criteria had higher sensitivity in both males and females, and the Cornell criteria had higher specificity in both groups. There was no correlation between LVMI by echo and amplitude of QRS voltage calculated as per SLC and CVC. Combining different criteria could improve the diagnostic accuracy of ECG.