Kothendaraman Bhuvaneswari, Serane V Tiroumourougane, Balasubramanian Kavitha
Department of Medicine, Indira Gandhi Medical College & Research Institute, Puducherry, IND.
Department of Pediatrics, A. G. Padmavati's Hospital, Puducherry, IND.
Cureus. 2023 Jun 12;15(6):e40306. doi: 10.7759/cureus.40306. eCollection 2023 Jun.
Left ventricular hypertrophy (LVH) detection is vital to the risk stratification of adults at risk of adverse cardiovascular events such as coronary heart disease, cerebrovascular disease, and aortic aneurysms. Electrocardiogram (ECG), a non-invasive, cost-effective instrument has been widely used as a screening tool for LVH. The objective of this study was to determine the diagnostic accuracy of seven frequently used ECG criteria in high-risk Indian adults in comparison with echocardiography.
ECG and transthoracic echocardiography were performed in adults older than 18 years with at least one cardiac risk factor (chronic hypertension, obesity, ischemic heart disease, and type 2 diabetes mellitus). Precision and accuracy were calculated for the various ECG criteria against LVH based on left ventricular mass index (LVMI) and cardiac remodeling by echocardiography.
A total of 220 participants were enrolled. Of these, 96 had LVH by echocardiography. There was marked variability in LVH detection by the different ECG criteria: 28 by Sokolow-Lyon criteria, 26 by Cornell criteria, 24 by Lewis criteria, 46 by Scott criteria, eight by Romhilt-Estes criteria, six by Modified Cornell criteria, and only two by Roberts criteria. Agreement statistics between ECG criteria and LVMI showed that none of them had a good agreement for LVH detection.
None of the ECG criteria were sensitive enough to rule out ventricular hypertrophy. In the context of cardiac remodeling, the ECG criteria had high sensitivity but low specificity and, hence, limited clinical relevance.
左心室肥厚（LVH）的检测对于有患冠心病、脑血管疾病和主动脉瘤等不良心血管事件风险的成年人进行风险分层至关重要。心电图（ECG）作为一种非侵入性、性价比高的工具，已被广泛用作LVH的筛查手段。本研究的目的是确定与超声心动图相比，七种常用心电图标准对高危印度成年人的诊断准确性。
对年龄超过18岁且至少有一项心脏危险因素（慢性高血压、肥胖、缺血性心脏病和2型糖尿病）的成年人进行心电图和经胸超声心动图检查。根据基于左心室质量指数（LVMI）的各种心电图标准和超声心动图检测的心脏重塑情况，计算其精确度和准确性。
共招募了220名参与者。其中，96人经超声心动图检查发现有LVH。不同心电图标准检测LVH的结果存在显著差异：Sokolow-Lyon标准检测出28例，Cornell标准检测出26例，Lewis标准检测出24例，Scott标准检测出46例，Romhilt-Estes标准检测出8例，改良Cornell标准检测出6例，Roberts标准仅检测出2例。心电图标准与LVMI之间的一致性统计显示，它们在检测LVH方面均无良好的一致性。
没有一种心电图标准对排除心室肥厚足够敏感。在心脏重塑的背景下，心电图标准具有高敏感性但低特异性，因此临床相关性有限。
