Peguero–Lo Presti criteria modified by body surface area for the electrocardiographic diagnosis of left ventricular hypertrophy in Thai patients

Abstract

Background Several electrocardiographic (ECG) criteria are used to diagnose left ventricular hypertrophy (LVH); however, they have low sensitivity. Objective To assess the sensitivity of LVH diagnosis using Peguero–Lo Presti criteria modified by body surface area (BSA). Methods This study used retrospective data from 9,438 patients who attended the Central Chest Institute of Thailand from January 2017 to December 2017 with available echocardiography, and who were categorized into those with and without LVH to determine diagnostic accuracy. We randomly selected 317 patients after excluding others based on various conditions. The left ventricular mass of the 317 patients was estimated using echocardiography. Peguero–Lo Presti criteria were modified by dividing original criteria by BSA. The accuracy of the modified criteria was compared with that of the original Peguero–Lo Presti, Sokolow–Lyon, and Cornell voltage criteria. A McNemar test was used to determine the agreement of all ECG criteria examined with LV mass index. The area under a receiver operating characteristic curve (AUC) was used to assess the performance of the criteria. Results LVH was diagnosed in 164 of the 317 patients using echocardiography. The sensitivity of modified Peguero–Lo Presti criteria was 50.6% (95% confidence interval [CI] 42.7% to 58.5%), and specificity was 88.2% (95% CI 82.0% to 92.9%), with an AUC of 0.67 (95% CI 0.61–0.73). Conclusions Peguero–Lo Presti criteria modified by dividing them by BSA can improve sensitivity with acceptable specificity for the diagnosis of LVH compared with other ECG criteria examined, at least in selected Thai patients. The modified Peguero–Lo Presti criteria have accuracy similar to that for the original criteria.