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. 2007 Oct 6;335(7622):711.
doi: 10.1136/bmj.39276.636354.AE. Epub 2007 Aug 28.

Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review

Daniel Pewsner  1 , Peter Jüni, Matthias Egger, Markus Battaglia, Johan Sundström, Lucas M Bachmann
Affiliations

Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review

Daniel Pewsner et al. BMJ. .

Abstract

Objective: To review the accuracy of electrocardiography in screening for left ventricular hypertrophy in patients with hypertension.

Design: Systematic review of studies of test accuracy of six electrocardiographic indexes: the Sokolow-Lyon index, Cornell voltage index, Cornell product index, Gubner index, and Romhilt-Estes scores with thresholds for a positive test of > or =4 points or > or =5 points.

Data sources: Electronic databases ((Pre-)Medline, Embase), reference lists of relevant studies and previous reviews, and experts.

Study selection: Two reviewers scrutinised abstracts and examined potentially eligible studies. Studies comparing the electrocardiographic index with echocardiography in hypertensive patients and reporting sufficient data were included.

Data extraction: Data on study populations, echocardiographic criteria, and methodological quality of studies were extracted.

Data synthesis: Negative likelihood ratios, which indicate to what extent the posterior odds of left ventricular hypertrophy is reduced by a negative test, were calculated.

Results: 21 studies and data on 5608 patients were analysed. The median prevalence of left ventricular hypertrophy was 33% (interquartile range 23-41%) in primary care settings (10 studies) and 65% (37-81%) in secondary care settings (11 studies). The median negative likelihood ratio was similar across electrocardiographic indexes, ranging from 0.85 (range 0.34-1.03) for the Romhilt-Estes score (with threshold > or =4 points) to 0.91 (0.70-1.01) for the Gubner index. Using the Romhilt-Estes score in primary care, a negative electrocardiogram result would reduce the typical pre-test probability from 33% to 31%. In secondary care the typical pre-test probability of 65% would be reduced to 63%.

Conclusion: Electrocardiographic criteria should not be used to rule out left ventricular hypertrophy in patients with hypertension.

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Conflict of interest statement

Competing interests: None declared.

Figures

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Fig 1 Flow chart of study selection process. MRI=magnetic resonance imaging
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Fig 2 Receiver operating curves of six commonly used electrocardiographic indexes for diagnosis of left ventricular hypertrophy. Each point represents one study
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Fig 3 Forest plots of negative likelihood ratio from test accuracy studies of six electrocardiographic indexes in diagnosis of left ventricular hypertrophy. Points represent estimates of likelihood ratio; lines represent 95% confidence intervals
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Fig 4 Forest plots of positive likelihood ratio from test accuracy studies of six electrocardiographic indexes in diagnosis of left ventricular hypertrophy. Points represent estimates of likelihood ratio; lines represent 95% confidence intervals
See this image and copyright information in PMC

Comment in

  • Diagnosing left ventricular hypertrophy in arterial hypertension.
    Nielsen OW, Sajadieh A. Nielsen OW, et al. BMJ. 2007 Oct 6;335(7622):681-2. doi: 10.1136/bmj.39344.470718.BE. BMJ. 2007. PMID: 17916817 Free PMC article.
  • Ethnicity is relevant.
    Vanezis AP, Bhopal R. Vanezis AP, et al. BMJ. 2007 Oct 20;335(7624):787. doi: 10.1136/bmj.39367.371736.BE. BMJ. 2007. PMID: 17947749 Free PMC article. No abstract available.
  • QRS voltage criteria can be useful.
    Bourdillon PJ. Bourdillon PJ. BMJ. 2007 Oct 20;335(7624):787. doi: 10.1136/bmj.39367.394155.BE. BMJ. 2007. PMID: 17947750 Free PMC article. No abstract available.
  • A scientifically based technique.
    Doepp M. Doepp M. Dtsch Arztebl Int. 2008 Apr;105(15):292; author reply 292. doi: 10.3238/arztebl.2008.0292a. Epub 2008 Apr 11. Dtsch Arztebl Int. 2008. PMID: 19629235 Free PMC article. No abstract available.

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