Sensitivity and specificity of commonly used electrocardiographic criteria for left atrial enlargement determined by m-mode echocardiography

Munuswamy, Kirubakaran; Alpert, Martin A.; Martin, Richard H.; Whiting, Richard B.; Mechlin, Norman J.

doi:10.1016/0002-9149(84)90413-2

Cited by 88 publications

(60 citation statements)

References 24 publications

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“…The criteria used for the diagnosis of P-wave abnormality in lead V 1 were: (1) bipeak interval in deeply notched P wave with (2) terminal forces equal to or more negative than À0.04 mm s, as obtained from the product of the depth of the terminal negative deflection and its duration. 19,20 The following other criteria were used for the diagnosis of LA abnormality in any other lead than V 1 :…”

Section: Ecgmentioning

confidence: 99%

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Additive value of standard ECG for the risk prediction of hypertensive disorders during pregnancy

Angeli

Verdecchia²,

Narducci

et al. 2011

Hypertens Res

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Prediction of hypertensive complications during pregnancy remains limited, especially in healthy and initially normotensive women. We conducted a prospective screening study for hypertensive complications in pregnant women. We studied 221 nulliparous healthy and normotensive women with singleton pregnancies whose first routine visit was carried out before the twelfth week of gestation. We tested several demographic, clinical and laboratory variables as predictors of a composite pool of prespecified events, including gestational hypertension, preeclampsia or eclampsia. We analyzed the potential additive role of ECG in the identification of women at increased risk of hypertensive disorders. Mean age at entry was 30 years. During pregnancy, there were 28 prespecified events (22 women with gestational hypertension, 5 with preeclampsia and 1 with eclampsia). In univariate analyses, blood pressure (BP), weight, body mass index (BMI) and left atrial (LA) abnormality detected by ECG in lead V 1 showed an association with the risk of hypertensive disorders (all Po0.05). In a multivariable analysis, only mean BP (OR: 3.08, 95% confidence interval (CI): 1.61-5.92; P¼0.001 for each 10 mm Hg increase) and LA abnormality in lead V 1 (OR: 4.35, 95% CI: 1.84-10.31; P¼0.001) were independent predictors of hypertensive disorders. The final model discriminated well between women who developed hypertensive disorders and women who remained normotensive (AUC¼0.75; 95% CI: 0.67-0.84; Po0.0001). This study suggests that standard ECG is valuable to refine risk stratification for hypertensive disorders in initially normotensive pregnant women. LA abnormality, easily detected by simple visual inspection of the traditional ECG, and mean arterial pressure (MAP), allows a rapid and effective risk stratification for hypertensive disorders.

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Section: Ecgmentioning

confidence: 99%

“…(1) bipeak interval in deeply notched P waves wider than 0.04 s or (2) P-wave/PR-segment ratio greater than 1.6 or (3) P wave higher than 3 mm or (4) total P-wave duration greater than 0.11 s. 19,20 …”

Section: Ecgmentioning

confidence: 99%

Additive value of standard ECG for the risk prediction of hypertensive disorders during pregnancy

Angeli

Verdecchia²,

Narducci

et al. 2011

Hypertens Res

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show abstract

“…In the past, several studies have assessed the accuracy of ECG criteria in prediction of LA enlargement using echocardiography and often demonstrated conflicting results [10][11][12][13] . Most of them reported relatively low sensitivity but much higher specificity of these criteria, often approximating 100% [10,12] .…”

Section: Discussionmentioning

confidence: 99%

Sensitivity and specificity of ECG criteria of left atrial enlargement in comparison to cardiac magnetic resonance in patients with hypertrophic cardiomyopathy

Kłopotowski¹,

Jasińska²,

Jarmus³

et al. 2016

Heart Beat

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Background. In patients with hypertrophic cardiomyopathy (HCM), left atrial (LA) enlargement has been related to increased risk of sudden cardiac death. Cardiac magnetic resonance (CMR) is the method of choice in the assessment of LA size and volume. However, initial assessment of LA enlargement is often made by means of ECG criteria including P wave analysis in leads II and V1. The aim of the study was to assess the sensitivity and specificity of ECG criteria for LA enlargement in relation to CMR. Materials and methods:The study included 236 patients (62.7% male, median age 47 years) with documented HCM and sinus rhythm on 12-lead ECG who underwent CMR study. ECGs were digitally analyzed for the following criteria: P wave duration in lead II >120 ms or area of negative P-terminal force in V1 ≥ 40 ms.mm. LA volume index (LAVI) > 53 ml/m 2 was used as a cut-off value of LA enlargement in CMR studies.Results: LA enlargement on ECG was found in 109 patients (46.2%) and on CMR in 48 patients (20.3%). Sensitivity, specificity, and positive and negative predictive values of LA enlargement based on P wave characteristics in lead II were 54.1%, 67.4%, 36.7% and 80.8% and in lead V1 32.8%, 80.0%, 36.4% and 77.3%. Conclusions:Current ECG criteria of LA enlargement have limited diagnostic value in detection of LA enlargement due to their low sensitivity and only moderate specificity.

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“…Criteria for ST-T changes were any of the following: (1) P wave morphology was analyzed in all of standard ECG leads. The criteria used for the diagnosis of P wave abnormality in lead V1 were: (1) bipeak interval in deeply notched P wave with (2) terminal forces equal to or more negative than -0.04 mmsec, as obtained from the product of the depth of the terminal negative deflection and its duration (37,38). The following other criteria were used for the diagnosis of LA abnormality in any other lead than V1: (1) bipeak interval in deeply notched P waves wider than 0,04 sec or (2) P-wave/PR-segment ratio greater than 1.6 or (3) P wave higher than 3 mm or (4) total P wave duration greater than 0.11 sec (37,38).…”

Section: Acta Facultatis Medicae Naissensis 2016;33(2):79-90mentioning

confidence: 99%

Risk Prediction Models for Hypertensive Disorders of Pregnancy: Role of 12-Lead Electrocardiography

Angeli¹,

Angeli²,

D’Antonio³

et al. 2016

Acta Facultatis Medicae Naissensis

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Hypertensive disorders represent the most common medical complications of pregnancy, affecting 6 to 8 percent of gestations. They may lead to severe maternal and fetal complications.Several observational studies have highlighted that weight, systolic and diastolic blood pressure, obtained at antenatal visit prior to 16 weeks, may be suitable to stratify the risk of developing hypertensive disorders during pregnancy.Recently, however, other markers have been proposed as potential predictors of hypertensive disorders during pregnancy. In this context, some electrocardiographic changes have shown significant power in refining risk stratification. Specifically, changes during pregnancy in QT interval and P wave morphology improved the accuracy of multivariable models for the prediction of hypertensive disorders. In particular, the presence of left atrial abnormalities at ECG seems to be associated with a marked increase in the risk of developing hypertensive disorders, and when included in a multivariable model taking into account some maternal features, it may discriminate between women who will develop hypertensive disorders during pregnancy and women who will remain normotensive. This prediction model was also able to identify pregnant women at increased risk for the occurrence of fetal/neonatal complications.The aim of the present overview is to discuss the available data supporting the evidence that specific ECG patterns occurring early in pregnancy may have clinical relevance for risk prediction of hypertensive disorders.

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Sensitivity and specificity of commonly used electrocardiographic criteria for left atrial enlargement determined by m-mode echocardiography

Cited by 88 publications

References 24 publications

Additive value of standard ECG for the risk prediction of hypertensive disorders during pregnancy

Additive value of standard ECG for the risk prediction of hypertensive disorders during pregnancy

Sensitivity and specificity of ECG criteria of left atrial enlargement in comparison to cardiac magnetic resonance in patients with hypertrophic cardiomyopathy

Risk Prediction Models for Hypertensive Disorders of Pregnancy: Role of 12-Lead Electrocardiography

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