Marcato João Pedro, Senra Santos Felipe, Gama Palone André, Lenci Marques Gustavo
Internal Medicine, Federal University of Paraná, Curitiba, BRA.
Cardiology, Heart Institute, Clinical Hospital, Faculty of Medicine, University of São Paulo, São Paulo, BRA.
Cureus. 2022 Jun 27;14(6):e26376. doi: 10.7759/cureus.26376. eCollection 2022 Jun.
Left ventricular hypertrophy (LVH) is an adaptive mechanism of the cardiac muscle due to increased activity demand or functional overload. The echocardiogram (ECHO) presents a better performance in relation to the electrocardiogram (ECG) for the diagnosis of LVH. However, the ECG is a low-cost and easy-to-reproduce diagnostic alternative and can be useful in services and locations where the ECHO is not yet easily accessible. Recently, a new criterion for LVH was proposed by Peguero-Lo Presti. The aim of this article was to evaluate the electrocardiographic criteria for the diagnosis of LVH (Sokolow-Lyon, Cornell voltage, Romhilt-Estes, and Peguero-Lo Presti) in comparison to the diagnosis made by the ECHO. ECHO and ECG from 142 patients' medical records were analyzed. Patients were divided into three groups according to the ECHO - control, eccentric LVH, and concentric LVH. Sensitivity, specificity, PPV, NPV, and accuracy of the four electrocardiographic criteria were evaluated in three scenarios - (1) LVH vs control, (2) concentric LVH vs control, and (3) eccentric LVH vs control. Of the 142 patients included in the study, 100 (70.4%) had LVH. According to the type of hypertrophy, the 100 patients with LVH were divided into two groups - 41 (28.8%) had eccentric LVH and 59 (41.5%) had concentric LVH. Of all the scenarios, the Peguero-Lo Presti criteria obtained the best sensitivity (1, 41%; 2, 33,9%; 3, 51,2%) and accuracy (1, 56,3%; 2, 58,4%; 3, 69,8%). The Sokolow-Lyon criteria showed greater specificity in all analyses (100%). None of the electrocardiographic criteria obtained sensitivity values that would justify the use of the electrocardiogram as a screening test for LVH. No differences were found for eccentric and concentric LVH in terms of diagnosis using electrocardiographic criteria. We recommend the use of these criteria to confirm the diagnosis of LVH, especially in low-complexity services that do not have image-based diagnostic tests.
左心室肥厚（LVH）是心肌因活动需求增加或功能负荷过重而产生的一种适应性机制。在诊断LVH方面，超声心动图（ECHO）相对于心电图（ECG）表现更佳。然而，ECG是一种低成本且易于重复的诊断方法，在尚未轻易获取ECHO的服务机构和场所可能会很有用。最近，佩格罗 - 洛·普雷斯蒂提出了一种新的LVH诊断标准。本文旨在比较ECHO诊断结果，评估用于诊断LVH的心电图标准（索科洛 - 里昂标准、康奈尔电压标准、罗姆希尔特 - 埃斯标准和佩格罗 - 洛·普雷斯蒂标准）。分析了142例患者病历中的ECHO和ECG数据。根据ECHO将患者分为三组——对照组、离心性LVH组和向心性LVH组。在三种情况下评估了四种心电图标准的敏感性、特异性、阳性预测值、阴性预测值和准确性：（1）LVH与对照组对比；（2）向心性LVH与对照组对比；（3）离心性LVH与对照组对比。在纳入研究的142例患者中，100例（70.4%）患有LVH。根据肥厚类型，100例LVH患者分为两组——41例（28.8%）为离心性LVH，59例（41.5%）为向心性LVH。在所有情况中，佩格罗 - 洛·普雷斯蒂标准获得了最佳敏感性（情况1为100%、情况2为41%、情况3为51.2%）和准确性（情况1为56.3%、情况2为58.4%、情况3为69.8%）。索科洛 - 里昂标准在所有分析中均显示出更高的特异性（100%）。没有任何心电图标准获得的敏感性值足以证明将心电图用作LVH筛查试验的合理性。在使用心电图标准进行诊断方面，离心性LVH和向心性LVH之间未发现差异。我们建议使用这些标准来确诊LVH，尤其是在没有基于图像的诊断测试的低复杂性服务机构中。
