Performance of electrocardiographic criteria for left ventricular hypertrophy as compared with cardiac computed tomography: from the Rule Out Myocardial Infarction Using Computer Assisted Tomography trial

Abstract

Objective Cardiac computed tomography (CT) is a state-of-the-art technology that provides an accurate noninvasive method to quantify left ventricular mass for analysis of left ventricular hypertrophy (LVH). We aimed to examine seven ECG-based LVH criteria against two CT indexation criteria for LVH: a CT-specific body surface area cutoff and the obesity-independent height2.7 criteria. Methods In 333 patients (mean age 53 ± 12 years, 61% men), 64-slice contrast-enhanced CT was performed and 12-lead surface ECG within 24 h. Left ventricular mass was measured at end-diastole. Using both CT indexation criteria, the cohort was subdivided into patients with LVH and without LVH. The seven ECG criteria for LVH were the Cornell voltage index, Cornell voltage duration product, Cornell/strain index, Sokolow–Lyon index, Romhilt–Estes scores at least 4 and at least 5, and Gubner–Ungerleider. Results The ECG parameters had high specificities (85–97%) and variable low sensitivities (4–43%) when compared to either CT criteria of LVH. The three Cornell-based methods performed the best (test-positive likelihood ratio: 4.5–6.7), followed by the Sokolow–Lyon and Romhilt–Estes scores (test-positive likelihood ratio: 2.3–4.0). With the exception of the Gubner–Ungerleider criterion, the other six ECG criteria were associated with at least one of the CT-based LVH (adjusted odds ratio 2.4–9.5) and had incremental predictive value beyond that of hypertension history. Conclusion Using cardiac CT as a gold standard for LVH assessment, ECG criteria for LVH have high specificities with the three Cornell-based criteria providing the best test performance for identifying patients with LVH.

Electrocardiographic diagnosis of the left ventricular hypertrophy in patients with left bundle branch block: Is it necessary to verify old criteria?

“…The sensitivity and specificity was lower in cases with LVMI > 215 g/m 2 than in those with LVMI > 115 g/m 2 . LVH ECG parameters were also verified with computer tomography in the study conducted by Truong et al [20]. The Cornel and Sokolov index achieved 22% and 35% sensitivity and 97% and 90% specificity.…”

A comparison of Cornell and Sokolow-Lyon electrocardiographic criteria for left ventricular hypertrophy in a military male population in Taiwan: the Cardiorespiratory fitness and HospItalization Events in armed Forces study

“…In addition, the Cornell voltage and product ECG criteria showed better sensitivity than the Sokolow-Lyon criteria under a fixed specificity of 95%. Most previous studies investigating the performance of different ECG criteria for LVH evaluated by echocardiography or magnetic resonance imaging were conducted in hypertensive patients of the Western countries (21,22). Some studies have shown that there was ethnical difference between hypertensive Whites and African Americans in the ECG diagnostic performance (23,24).…”

ECG left ventricular hypertrophy is a stronger risk factor for incident cardiovascular events in women than in men in the general population

“…Altogether, it seems that sex-unspecific dichotomous ECG LVH criteria may produce LVH overdiagnosis in some men and/or underdiagnosis in some women. When left ventricular mass has been estimated with echocardiography or computer tomography, the Cornell-based criteria have shown higher correlation with left ventricular mass than sex-unspecific criteria [7,30].…”