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. 2023 Jun 12;15(6):e40306.
doi: 10.7759/cureus.40306. eCollection 2023 Jun.

Are Electrocardiographic Criteria Reliable for Left Ventricular Hypertrophy Detection in Indian Adults?

Bhuvaneswari Kothendaraman  1 , Tiroumourougane Serane V  2 , Kavitha Balasubramanian  1
Affiliations

Are Electrocardiographic Criteria Reliable for Left Ventricular Hypertrophy Detection in Indian Adults?

Bhuvaneswari Kothendaraman et al. Cureus. .

Abstract

Background: Left ventricular hypertrophy (LVH) detection is vital to the risk stratification of adults at risk of adverse cardiovascular events such as coronary heart disease, cerebrovascular disease, and aortic aneurysms. Electrocardiogram (ECG), a non-invasive, cost-effective instrument has been widely used as a screening tool for LVH. The objective of this study was to determine the diagnostic accuracy of seven frequently used ECG criteria in high-risk Indian adults in comparison with echocardiography.

Methods: ECG and transthoracic echocardiography were performed in adults older than 18 years with at least one cardiac risk factor (chronic hypertension, obesity, ischemic heart disease, and type 2 diabetes mellitus). Precision and accuracy were calculated for the various ECG criteria against LVH based on left ventricular mass index (LVMI) and cardiac remodeling by echocardiography.

Results: A total of 220 participants were enrolled. Of these, 96 had LVH by echocardiography. There was marked variability in LVH detection by the different ECG criteria: 28 by Sokolow-Lyon criteria, 26 by Cornell criteria, 24 by Lewis criteria, 46 by Scott criteria, eight by Romhilt-Estes criteria, six by Modified Cornell criteria, and only two by Roberts criteria. Agreement statistics between ECG criteria and LVMI showed that none of them had a good agreement for LVH detection.

Conclusion: None of the ECG criteria were sensitive enough to rule out ventricular hypertrophy. In the context of cardiac remodeling, the ECG criteria had high sensitivity but low specificity and, hence, limited clinical relevance.

Keywords: 12-lead ecg; ecg criteria; echocardiography; left ventricular hypertrophy; south indian.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. M mode in parasternal long axis view of transthoracic echo showing measurement of various parameters of left ventricular mass
LVEDd: LV end diastolic diameter; IVSd: intraventricular septal diameter; LVPWd: LV posterior wall diastolic thickness
Figure 2
Figure 2. Age and gender-wise distribution of the study population
Figure 3
Figure 3. Flow diagram of the diagnostic accuracy of the ECG criteria
ECHO: Echocardiography
See this image and copyright information in PMC

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