Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Unidade de Eletrocardiografia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina , Universidade de Sao Paulo, Av. Dr Enéas de Carvalho Aguiar, 44, Andar AB, Sao Paulo, SP, 05403-900, Brazil.
Sci Rep. 2021 Jun 1;11(1):11516. doi: 10.1038/s41598-021-91083-9.
Recently, a new ECG criterion, the Peguero-Lo Presti (PLP), improved overall accuracy in the diagnosis of left ventricular hypertrophy (LVH)-compared to traditional ECG criteria, but with few patients with advanced age. We analyzed patients with older age and examined which ECG criteria would have better overall performance. A total of 592 patients were included (83.1% with hypertension, mean age of 77.5 years) and the PLP criterion was compared against Cornell voltage (CV), Sokolow-Lyon voltage (SL) and Romhilt-Estes criteria (cutoffs of 4 and 5 points, RE4 and RE5, respectively) using LVH defined by the echocardiogram as the gold standard. The PLP had higher AUC than the CV, RE and SL (respectively, 0.70 vs 0.66 vs 0.64 vs 0.67), increased sensitivity compared with the SL, CV and RE5 (respectively, 51.9% [95% CI 45.4-58.3%] vs 28.2% [95% CI 22.6-34.4%], p < 0.0001; vs 35.3% [95% CI 29.2-41.7%], p < 0.0001; vs 44.4% [95% CI 38.0-50.9%], p = 0.042), highest F1 score (58.3%) and net benefit for most of the 20-60% threshold range in the decision curve analysis. Overall, despite the best diagnostic performance in older patients, the PLP criterion cannot rule out LVH consistently but can potentially be used to guide clinical decision for echocardiogram ordering in low-resource settings.
最近，一种新的心电图标准，即 Peguero-Lo Presti（PLP）标准，与传统心电图标准相比，提高了左心室肥厚（LVH）的整体诊断准确性——但患者年龄较大。我们分析了年龄较大的患者，并研究了哪种心电图标准具有更好的整体性能。共纳入 592 例患者（83.1%为高血压患者，平均年龄 77.5 岁），并将 PLP 标准与 Cornell 电压（CV）、Sokolow-Lyon 电压（SL）和 Romhilt-Estes 标准（分别为 4 分和 5 分，RE4 和 RE5）进行比较，以超声心动图定义的 LVH 为金标准。PLP 的 AUC 高于 CV、RE 和 SL（分别为 0.70 比 0.66 比 0.64 比 0.67），与 SL、CV 和 RE5 相比，敏感性更高（分别为 51.9%[95%CI 45.4-58.3%]比 28.2%[95%CI 22.6-34.4%]，p<0.0001；比 35.3%[95%CI 29.2-41.7%]，p<0.0001；比 44.4%[95%CI 38.0-50.9%]，p=0.042），F1 评分最高（58.3%），在决策曲线分析的 20%-60%阈值范围内的净收益最高。总体而言，尽管在老年患者中具有最佳诊断性能，但 PLP 标准不能始终排除 LVH，但可能有助于在资源有限的环境中指导超声心动图检查的临床决策。
