Gamrat Aleksandra, Trojanowicz Katarzyna, Surdacki Michał A, Budkiewicz Aleksandra, Wąsińska Adrianna, Wieczorek-Surdacka Ewa, Surdacki Andrzej, Chyrchel Bernadeta
Students' Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland.
Chair and Department of Nephrology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland.
J Clin Med. 2021 Jun 28;10(13):2864. doi: 10.3390/jcm10132864.
Traditional electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH), introduced in the pre-echocardiographic era of diagnosis, have a relatively low sensitivity (usually not exceeding 25-40%) in detecting LVH. A novel Peguero-Lo Presti ECG-LVH criterion was recently shown to exhibit a higher sensitivity than the traditional ECG-LVH criteria in hypertension. Our aim was to test the diagnostic ability of the novel Peguero-Lo Presti ECG-LVH criterion in severe aortic stenosis. We retrospectively analyzed 12-lead ECG tracings and echocardiographic records from the index hospitalization of 50 patients with isolated severe aortic stenosis (mean age: 77 ± 10 years; 30 women and 20 men). Exclusion criteria included QRS > 120 ms, bundle branch blocks or left anterior fascicular block, a history of myocardial infarction, more than mild aortic or mitral regurgitation, and significant LV dysfunction by echocardiography. We compared the agreement of the novel Peguero-Lo Presti criterion and traditional ECG-LVH criteria with echocardiographic LVH (LV mass index > 95 g/m in women and >115 g/m in men). Echocardiographic LVH was found in 32 out of 50 study patients. The sensitivity of the Peguero-Lo Presti criterion in detecting LVH was improved (55% vs. 9-34%) at lower specificity (72% vs. 78-100%) in comparison to 8 single traditional ECG-LVH criteria. Additionally, the positive predictive value (77% vs. 72%), positive likelihood ratio (2.0 vs. 1.5), and odds ratio (3.2 vs. 2.4) were higher for the Peguero-Lo Presti criterion versus the presence of any of these 8 traditional ECG-LVH criteria. Cohen's Kappa, a measure of concordance between ECG and echocardiography with regard to LVH, was 0.24 for the Peguero-Lo Presti criterion, -0.01-0.13 for single traditional criteria, and 0.20 for any traditional criterion. However, by the receiver operating characteristics (ROC) curve analysis, the overall ability to discriminate between patients with and without LVH was insignificantly lower for the Peguero-Lo Presti versus Cornell voltage as a continuous variable (area under the ROC curve: 0.65 (95% CI, 0.48-0.81) vs. 0.71 (0.55-0.86), = 0.5). In conclusion, our preliminary results suggest a slightly better, albeit still low, agreement of the novel Peguero-Lo Presti ECG criterion compared to the traditional ECG-LVH criteria with echocardiographic LVH in severe aortic stenosis.
左心室肥厚（LVH）的传统心电图（ECG）标准是在超声心动图诊断时代之前引入的，在检测LVH方面灵敏度相对较低（通常不超过25%-40%）。最近一项新的佩格罗-洛·普雷斯蒂ECG-LVH标准显示，在高血压患者中，其灵敏度高于传统的ECG-LVH标准。我们的目的是测试新的佩格罗-洛·普雷斯蒂ECG-LVH标准对严重主动脉瓣狭窄的诊断能力。我们回顾性分析了50例孤立性严重主动脉瓣狭窄患者（平均年龄：77±10岁；30名女性和20名男性）首次住院时的12导联心电图记录和超声心动图记录。排除标准包括QRS>120毫秒、束支传导阻滞或左前分支阻滞、心肌梗死病史、中重度以上主动脉瓣或二尖瓣反流以及超声心动图显示的明显左心室功能障碍。我们比较了新的佩格罗-洛·普雷斯蒂标准和传统ECG-LVH标准与超声心动图LVH（女性LV质量指数>95g/m²，男性>115g/m²）的一致性。50例研究患者中有32例发现有超声心动图LVH。与8项单一传统ECG-LVH标准相比，佩格罗-洛·普雷斯蒂标准检测LVH的灵敏度有所提高（55%对9%-34%），但特异性较低（72%对78%-100%）。此外，佩格罗-洛·普雷斯蒂标准的阳性预测值（77%对72%）、阳性似然比（2.0对1.5）和比值比（3.2对2.4）均高于这8项传统ECG-LVH标准中的任何一项。关于LVH，ECG与超声心动图之间一致性的衡量指标科恩kappa系数，佩格罗-洛·普雷斯蒂标准为0.
