Hamed Mohamed, Dasari Gopika, Casale Joel A, Kaur Navneet, Karl Mitchell
Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA.
Pulmonology and Critical Care, University of Southern California, Los Angeles, USA.
Cureus. 2022 Aug 14;14(8):e28003. doi: 10.7759/cureus.28003. eCollection 2022 Aug.
Background The ECG diagnosis of left ventricular hypertrophy (LVH) has been challenging for over a hundred years. ECG diagnosis of LVH has shown good specificity but lacks sensitivity. In addition, voltage-based criteria can be affected by multiple conditions such as obesity and chronic lung disease. Therefore, we sought to compare Romhilt-Estes (R-E) criteria with commonly used voltage-based criteria in presumptive ECG diagnosis of LVH. Methods This is a retrospective electronic medical record study from September 1, 2017, to September 1, 2018, of 499 consecutive ECGs from Boca Raton Regional Hospital. Different ECG criteria were used to identify the presence of LVH, including the Cornell criteria, modified Cornell criteria, Sokolow-Lyon criteria, and Romhilt-Estes criteria. The main study outcome was to compare the R-E criteria in presumptive ECG diagnosis of LVH to the voltage-based criteria (Cornell, modified Cornell, and Sokolow-Lyon). Results After analyzing the ECGs using the different ECG criteria, R-E criteria were positive with LVH present (score ≥ 5 points) in 162 patients. In contrast, Cornell criteria were positive in 42 patients (8.4%), modified Cornell criteria in 50 patients (10%), and Sokolow-Lyon criteria in 13 patients (2.6%). In addition, R-E criteria showed higher positivity of LVH diagnosis compared to the sum of three voltage-based criteria (32.7% versus 21% respectively, p<0.001). Conclusion We presume that R-E criteria can help better diagnose LVH by ECG compared to other commonly-used voltage-based criteria. However, further studies are needed using confirmatory imaging to confirm the accuracy of R-E criteria and compare it with other voltage based-criteria.
一百多年来，心电图诊断左心室肥厚（LVH）一直具有挑战性。LVH的心电图诊断具有良好的特异性，但缺乏敏感性。此外，基于电压的标准可能会受到多种情况的影响，如肥胖和慢性肺病。因此，我们试图在LVH的推测性心电图诊断中，将Romhilt-Estes（R-E）标准与常用的基于电压的标准进行比较。
这是一项回顾性电子病历研究，研究对象为2017年9月1日至2018年9月1日来自博卡拉顿地区医院的499份连续心电图。使用不同的心电图标准来确定LVH的存在，包括康奈尔标准、改良康奈尔标准、索科洛夫-里昂标准和Romhilt-Estes标准。主要研究结果是将LVH推测性心电图诊断中的R-E标准与基于电压的标准（康奈尔、改良康奈尔和索科洛夫-里昂）进行比较。
使用不同的心电图标准分析心电图后，R-E标准在162例LVH患者中呈阳性（评分≥5分）。相比之下，康奈尔标准在42例患者（8.4%）中呈阳性，改良康奈尔标准在50例患者（10%）中呈阳性，索科洛夫-里昂标准在13例患者（2.6%）中呈阳性。此外，与三个基于电压的标准之和相比，R-E标准显示出更高的LVH诊断阳性率（分别为32.7%对21%，p<0.001）。
我们推测，与其他常用的基于电压的标准相比，R-E标准有助于通过心电图更好地诊断LVH。然而，需要进一步使用确证性成像研究来确认R-E标准的准确性，并将其与其他基于电压的标准进行比较。
