Novel Electrocardiographic Criteria for the Diagnosis of Left Ventricular Hypertrophy in the Japanese General Population

Narita, Michiko; Yamada, Masahiro; Tsushima, Megumi; Kudo, Naoko; Kato, Tomo; Yokono, Yoshikazu; Toyama, Yuichi; Senoo, Maiko; Yonekura, Manabu; Narita, N; Kimura, Yuichi; Sawada, Kaori; Tokuda, Itoyo; Tomita, Hirofumi

doi:10.1536/ihj.18-511

Cited by 16 publications

(18 citation statements)

References 36 publications

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“…Our data suggest that the efficacy of the deep S wave in the mid-precordial leads shifts from V3 to V4 with age and/or with the development of HCM phenotypes. Our findings are consistent with reports that SD+SV4 13 or RI+SV4 14 were the most effective screening criteria for adult patients with LVH, both of which include SV4.…”

Section: Advance Publicationsupporting

confidence: 93%

Electrocardiographic Diagnosis of Hypertrophic Cardiomyopathy in the Pre- and Post-Diagnostic Phases in Children and Adolescents

Yoshinaga

Horigome

Ayusawa

et al. 2021

Circ J

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Background:The usefulness of electrocardiographic (ECG) voltage criteria for diagnosing hypertrophic cardiomyopathy (HCM) in pediatric patients is poorly defined. Methods and Results:ECGs at the 1st grade (mean [±SD] age 6.6±0.3 years) were available for 11 patients diagnosed with HCM at around the 7th grade (13.2±0.3 years). ECGs were available for another 64 patients diagnosed with HCM in the 1st (n=15), 7th (n=32), and 10th (n=17) grades. Fifty-one voltage criteria were developed by grade and sex using 62,841 ECGs from the general population. Voltage criteria were set at the 99.95th percentile (1/2,000) point based on the estimated prevalence of childhood HCM (2.9 per 100,000 [1/34,483]) to decrease false negatives. Conventional criteria were from guidelines for school-aged children in Japan. Of 11 patients before diagnosis, 2 satisfied conventional criteria in 1st grade; 5 (56%) of the remaining 9 patients fulfilled 2 voltage criteria (R wave in limb-lead I [RI]+S wave in lead V3 [SV3] and R wave in lead V3 [RV3]+SV3). Robustness analysis for sensitivity showed RV3+SV3 was superior to RI+SV3. For all patients after diagnosis, RI+SV4 was the main candidate. However, conventional criteria were more useful than voltage criteria. Conclusions:Early HCM prediction was possible using RV3+SV3 in >50% of patients in 1st grade. Voltage criteria may help diagnose prediagnostic or early HCM, and prevent tragic accidents, although further prospective studies are required.

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Section: Advance Publicationsupporting

confidence: 93%

Electrocardiographic Diagnosis of Hypertrophic Cardiomyopathy in the Pre- and Post-Diagnostic Phases in Children and Adolescents

Yoshinaga

Horigome

Ayusawa

et al. 2021

Circ J

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“…After the original publication of the Peguero-Lo Presti criterion several other groups compared the sensitivity of the novel electrocardiographic criterion with other ECG criteria with conflicting results 32 , 38 – 45 . The PLP criterion also predicted LVH in another cohort of patients with aortic stenosis 46 and mortality in a clustered probability sample of the general population 5 .…”

Section: Discussionmentioning

confidence: 99%

Clinical applicability and diagnostic performance of electrocardiographic criteria for left ventricular hypertrophy diagnosis in older adults

Tavares

Samesima

Hajjar

et al. 2021

Sci Rep

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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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“…These inconsistent results from different population may be explained by ethnicity, sample population, and enrollment of participants, as aforementioned in previous studies (Peter et al, 2017; Sun et al, 2018). Despite of the numerous ECG‐LVH criteria, it is warranted to explore better screening method for different regional population (Narita et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

The association between ECG criteria and Echo criteria for left ventricular hypertrophy in a general Chinese population

Yuan

Yang

et al. 2021

Noninvasive Electrocardiol

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Background Several ECG criteria have been widely used for diagnosis of left ventricular hypertrophy (LVH) in clinical practice. However, their performance in a general Chinese population is limited. Methods and results A multi‐stage, stratified cluster sampling across China was performed and 7415 representative Chinese adults aged 18–85 years were analyzed. ECG was collected by using GE MAC 5500 machine. The association between five ECG‐LVH criteria (i.e., Peguero–Lo Presti, Cornell, Cornell product, Sokolow–Lyon and Sokolow–Lyon product) and echocardiographic LVH (Echo‐LVH) was assessed by Pearson's correlation, diagnostic statistics like predictive values, and receiver operating characteristics (ROC) curve. We found that the prevalence of the Echo‐LVH was 11% while ECG‐LVH ranged from 3% to 27%. All ECG‐LVH criteria had high negative predictive value (NPV) (89%) and specificity (73–96%) but low positive predictive value (PPV) (12–24%) and sensitivity (4–29%). The newly Peguero–Lo Presti criteria had higher sensitivity (29%) but lower specificity (73%) and accuracy (68%) compared with other criteria. Cornell product had the best diagnostic performance (AUC: 0.59), as well as the highest specificity (96%) and accuracy (86%) but lowest sensitivity (4%). Among single‐lead components of ECG criteria, RaVL voltage and QRS duration performed relatively better than others. Hypertensive and older individuals had higher sensitivity but lower specificity and accuracy than their counterparts. Conclusion ECG‐LVH criteria had high NPV to detect Echo‐LVH. Though with higher sensitivity, Peguero–Lo Presti criteria did not have better diagnostic performance to detect Echo‐LVH. RaVL and QRS duration had stronger association with Echo‐LVH among all single‐lead components.

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Novel Electrocardiographic Criteria for the Diagnosis of Left Ventricular Hypertrophy in the Japanese General Population

Cited by 16 publications

References 36 publications

Electrocardiographic Diagnosis of Hypertrophic Cardiomyopathy in the Pre- and Post-Diagnostic Phases in Children and Adolescents

Electrocardiographic Diagnosis of Hypertrophic Cardiomyopathy in the Pre- and Post-Diagnostic Phases in Children and Adolescents

Clinical applicability and diagnostic performance of electrocardiographic criteria for left ventricular hypertrophy diagnosis in older adults

The association between ECG criteria and Echo criteria for left ventricular hypertrophy in a general Chinese population

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