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VOLUME 1 , ISSUE 2 ( July-December, 2017 ) > List of Articles


A Comparative Study of Electrocardiographic and Echocardiographic Evidence of Left ventricular Hypertrophy

Gurinder Mohan, Ranjeet Kaur, Ankur Kamra, Aakash Aggarwal

Keywords : Cornell, Echocardiography, Electrocardiogram, Romhilt–Estes score, Sokolow–Lyon

Citation Information : Mohan G, Kaur R, Kamra A, Aggarwal A. A Comparative Study of Electrocardiographic and Echocardiographic Evidence of Left ventricular Hypertrophy. Curr Trends Diagn Treat 2017; 1 (2):59-63.

DOI: 10.5005/jp-journals-10055-0014

License: NA

Published Online: 01-12-2017

Copyright Statement:  NA


Introduction: The increased risk of morbidity and mortality associated with left ventricular hypertrophy (LVH) diagnosed by electrocardiogram (ECG) or echocardiography is well known. The aim of the study was to evaluate ECG and echocardiography evidence of LVH in patients provisionally diagnosed to have LVH on clinical assessment and to determine the sensitivity and specificity of different criteria of LVH on ECG in comparison with echocardiography. Materials and methods: Hundred patients provisionally diagnosed to have LVH based on clinical assessment were enrolled in this study. A standard 12-lead ECG was recorded. Left ventricular hypertrophy was measured on ECG by applying following criteria: Sokolow–Lyon, Cornell, Romhilt–Estes score. Using two-dimensional echocardiography as the gold standard, LVH was calculated. Sensitivity and specificity of different criteria of ECG were calculated in comparison with echocardiography. Results: Out of 100 patients suspected to have LVH, 91 patients were found to have LVH on echocardiography. Indicating that echocardiography has sensitivity of 91% and diagnostic accuracy of 91%. On comparing different criteria, Sokolow criterion was found to have maximum sensitivity of 38.46%, while Cornell criterion was least sensitive, i.e., 14.29%, and sensitivity of Romhilt–Estes criterion was 19.78%. However, overall sensitivity of ECG can be increased by combining all the criteria, i.e., to 45.05%. Specificity of different criteria of ECG was high, i.e., as much as 100% in case of Romhilt–Estes criterion, while overall specificity of ECG was 77.778%. Conclusion: Sensitivity and diagnostic accuracy of ECG were very low in comparison with echocardiography in detecting LVH; therefore, ECG cannot replace echocardiography in detecting LVH. Overall sensitivity of different criteria of ECG was low. However, sensitivity of ECG can be increased by combining Sokolow-Lyons voltage criteria and Cornell voltage criteria with Romhilt–Estes point score.

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  1. Kannel WB, Levy D, Cupples LA. Left ventricular hypertrophy and risk of cardiac failure: insight from the Framingham study. J Cardiovasc Pharmacol 1987;10(Suppl 6):S153-S140.
  2. Devereux RB, Reicheck N. Echocardiography determination of left ventricular mass in men. Anatomic validation of the method. Circulation 1997 Apr;55(4):613-618.
  3. Levy D, Labib SB, Anderson KM, Christ JC, Kannel WB, Castelli WP. Determinants of sensitivity and specificity of ECG criteria for left ventricular hypertrophy. Circulation 1990 Mar;81(3):815-820.
  4. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, et al; National Heart, Lung, and Blood Institute Joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003 May;289(19):2560-2572.
  5. Driscoll D, Bistrian B. Parenteral and enteral nutrition in the intensive care unit. In: Irwin R, Rippe J, editors. Intensive care medicine. 2nd ed. Philadelphia (PA): Lippincott Williams & Wilkins; 2003. pp. 343-345.
  6. Mosteller RD. Simplified calculation of body surface area. N Engl J Med 1987 Oct;317(17):1098.
  7. Mirvis DM. Electrocardiography. In: Braunwald E, Libby P, Bonow RO, Mann DL, Zipes DP, editors. Braunwald's heart disease a textbook of cardiovascular medicine. 8th ed. Vol. 2. Philadelphia (PA): Elsevier; 2007. p. 164.
  8. Foppa M, Duncan BB, Rohde LE. Echocardiography-based left ventricular mass estimation. How should we define hypertrophy? Cardiovasc Ultrasound 2005 Jun;3:17.
  9. Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantization in M-mode echocardiography: results of a survey of echocardiographic methods. Circulation 1978 Dec;58(6):1072-1083.
  10. Connolly HM. Echocardiography. In: Braunwald E, Libby P, Bonow RO, Mann DL, Zipes DP, editors. Braunwald's heart disease a textbook of cardiovascular medicine. 8th ed. Vol. 2. Philadelphia (PA): Elsevier; 2007. pp. 246-296.
  11. Levy D, Savage DD, Garrison RJ, Anderson KM, Kannel WB, Castelli WP. Echocardiographic criteria for left ventricular hypertrophy: the Framingham Heart Study. Am J Cardiol 1987 Apr;59(9):956-960.
  12. Anis M, Ishaq M, Kundi A, Shah S. Echocardiography correlation of left ventricular mass index in normotensive and hypertensive Pakistani population. Pak J Cardiol 2000;11(1): 9-21.
  13. Woythaler JA, Singer SL, Kwan OL, Meltzer RS, Reubner B, Bommer W, DeMaria A. Accuracy of echocardiography versus electrocardiography in detecting left ventricular hypertrophy: comparison with postmortem mass measurements. J Am Coll Cardiol 1983 Aug;2(2):305-311.
  14. Holt JH Jr, Barnard ACL, Lynn MS, Svendsen P, Kramer JO Jr. A study of the human heart as a multiple dipole electrical source: II. Diagnosis and quantification of left ventricular hypertrophy. Circulation 1969;40:697-710.
  15. Reichek N, Devereux RB. Left ventricular hypertrophy: relationship of anatomic echocardiographic and electrocardiographic findings. Circulation 1981 Jun;63(6):1391-1398.
  16. Devereux RB, Phillips MC, Casale PN, Eisenberg RR, Kligfield P. Geometric determinants of electrocardiographic left ventricular hypertrophy. Circulation 1983 Apr;67(4):907-911.
  17. Pewsner D, Jüni P, Egger M, Battaglia M, Sundström J, Bachmann LM. Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review. BMJ 2007 Oct;335(7622):711.
  18. Sokolow M, Lyon TP. The ventricular complex in left ventricular hypertrophy as obtained by unipolar and precordial limb leads. Am Heart J 1949 Feb;37(2):161-186.
  19. Casale PN, Devereux RB, Kligfield P, Eisenberg RR, Miller DH, Chaudhary BS, Phillips MC. Electrocardiographic detection of left ventricular hypertrophy: development and prospective validation of improved criteria. J Am Coll Cardiol 1985 Sep;6(3):572-580.
  20. Dada A, Adebiyi AA, Aje A, Oladapo OO, Falase AO. Standard electrocardiographic criteria for left ventricular hypertrophy in nigerian hypertensives. Ethn Dis 2005 Autumn;15(4): 578-584.
  21. Okin PM, Roman MJ, Devereux RB, Borer JS, Kligfield P. Electrocardiografic diagnosis of left ventricular hypertrophy by the time-voltage integral of the QRS complex. J Am Coll Cardiol 1994 Jan;23(1):133-140.
  22. Hameed W, Razi MS, Khan MA, Hussain MM, Aziz S, Habib S, Aslam SHM. Electrocardiographic diagnosis of left ventricular hypertrophy: comparison with echocardiography. Pak J Physiol 2005;1(1-2):35-38.
  23. Domingos H, Luzio JCE, de Leles GN, Sauer L, Ovando LA. Correlação eletro—ecocardiográfica no diagnóstico da hipertrofia ventricular esquerda. Arq Bras Cardiol 1998 Jul;71(1):31-35.
  24. Colossimo AP, de Assis Costa F, Riera AR, Bombig MT, Lima VC, Fonseca FA, Izar MC, Filho BL, Souza D, Povoa RM. Electrocardiogram sensitivity in left ventricular hypertrophy according to gender and cardiac mass. SBC 1992;43:661.
  25. Casiglia E, Schiavon L, Tikhonoff V, Bascelli A, Martini B, Mazza A, Caffi S, D'Este D, Bagato F, Bolzon M, et al. Electrocardiographic criteria of left ventricular hypertrophy in general population. Eur J Epidemiol 2008 Mar;23(4):262-271.
  26. Alfakih K1, Walters K, Jones T, Ridgway J, Hall AS, Sivananthan M. New gender-specific partition values for ECG criteria of left ventricular hypertrophy: recalibration against cardiac MRI. Hypertension 2004 Aug;44(2):175-179.
  27. González-Juanatey JR, Cea-Calvo L, Bertomeu V, Aznar J; for Investigators study VIIDA. Electrocardiographic criteria for left ventricular hypertrophy and cardiovascular risk in hypertensives. VIIDA study. Rev Esp Cardiol 2007 Feb;60(2):148-156.
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