Dataset Information

Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review.

ABSTRACT:

Objective

To review the accuracy of electrocardiography in screening for left ventricular hypertrophy in patients with hypertension.

Design

Systematic review of studies of test accuracy of six electrocardiographic indexes: the Sokolow-Lyon index, Cornell voltage index, Cornell product index, Gubner index, and Romhilt-Estes scores with thresholds for a positive test of > or =4 points or > or =5 points.

Data sources

Electronic databases ((Pre-)Medline, Embase), reference lists of relevant studies and previous reviews, and experts.

Study selection

Two reviewers scrutinised abstracts and examined potentially eligible studies. Studies comparing the electrocardiographic index with echocardiography in hypertensive patients and reporting sufficient data were included.

Data extraction

Data on study populations, echocardiographic criteria, and methodological quality of studies were extracted.

Data synthesis

Negative likelihood ratios, which indicate to what extent the posterior odds of left ventricular hypertrophy is reduced by a negative test, were calculated.

Results

21 studies and data on 5608 patients were analysed. The median prevalence of left ventricular hypertrophy was 33% (interquartile range 23-41%) in primary care settings (10 studies) and 65% (37-81%) in secondary care settings (11 studies). The median negative likelihood ratio was similar across electrocardiographic indexes, ranging from 0.85 (range 0.34-1.03) for the Romhilt-Estes score (with threshold > or =4 points) to 0.91 (0.70-1.01) for the Gubner index. Using the Romhilt-Estes score in primary care, a negative electrocardiogram result would reduce the typical pre-test probability from 33% to 31%. In secondary care the typical pre-test probability of 65% would be reduced to 63%.

Conclusion

Electrocardiographic criteria should not be used to rule out left ventricular hypertrophy in patients with hypertension.

SUBMITTER: Pewsner D

PROVIDER: S-EPMC2001078 | biostudies-literature | 2007 Oct

REPOSITORIES: biostudies-literature

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Publications

Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review.

Pewsner Daniel D Jüni Peter P Egger Matthias M Battaglia Markus M Sundström Johan J Bachmann Lucas M LM

BMJ (Clinical research ed.) 20070828 7622

<h4>Objective</h4>To review the accuracy of electrocardiography in screening for left ventricular hypertrophy in patients with hypertension.<h4>Design</h4>Systematic review of studies of test accuracy of six electrocardiographic indexes: the Sokolow-Lyon index, Cornell voltage index, Cornell product index, Gubner index, and Romhilt-Estes scores with thresholds for a positive test of > or =4 points or > or =5 points.<h4>Data sources</h4>Electronic databases ((Pre-)Medline, Embase), reference list ...[more]

PMID: 17726091

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Project description:Left ventricular hypertrophy is a significant independent risk factor for all-cause mortality and morbidity, and an accurate diagnosis at an early stage of heart change is clinically significant. Electrocardiography is the most convenient, economical, and non-invasive method for screening in primary care. However, the coincidence rate of the actual left ventricular hypertrophy and diagnostic findings was low, consequently increasing the interest in algorithms using big data and deep learning. We attempted to diagnose left ventricular hypertrophy using big data and deep learning algorithms, and aimed to confirm its diagnostic power according to the differences between males and females. This retrospective study used electrocardiographs obtained at Yonsei University Wonju Severance Christian Hospital, Wonju, Korea, from October 2010 to February 2020. Binary classification was performed for primary screening for left ventricular hypertrophy. Three datasets were used for the experiment: the male, female, and entire dataset. A cutoff for binary classification was defined as the meaningful as a screening test (<132 g/m2 vs. ≥132 g/m2, <109 g/m2 vs. ≥109 g/m2). Six types of input were used for the classification tasks. We attempted to determine whether electrocardiography had predictive power for left ventricular hypertrophy diagnosis. For the entire dataset, the model achieved an area under the receiver operating characteristic (AUROC) curve of 0.836 (95% CI, 0.833-838) with a sensitivity of 78.37% (95% CI, 76.79-79.95). For the male dataset, the AUROC was 0.826 (95% CI, 0.822-830) with a sensitivity of 76.73% (95% CI, 75.14-78.33). For the female dataset, the AUROC was 0.772 (95% CI, 0.769-775) with a sensitivity of 72.90% (95% CI, 70.33-75.46). Our model confirmed that left ventricular hypertrophy can be classified to some extent using electrocardiography, demographics, and electrocardiography features. In particular, a learning environment that considered gender differences was constructed. Consequently, the difference in diagnostic power between men and women was confirmed. Our model will help patients with suspected left ventricular hypertrophy to undergo screening tests at a low cost. In addition, our research and attempts will show the expected effect that gender-consideration approaches can help with various currently proposed diagnostic methods.

Project description:BackgroundThe Peguero-Lo Presti criteria are novel electrocardiographic (ECG) diagnostic criteria for the detection of left ventricular hypertrophy (LVH) and represent the sum of the amplitude of the deepest S wave in any lead with the S wave in lead V4 (SD+SV4). The diagnostic efficacy of the Peguero-Lo Presti criteria in LVH is still debatable. We aimed to test the sensitivity and specificity of the Peguero-Lo Presti criteria and compared them with those of the Cornell voltage index to assess their overall performance in LVH diagnosis.MethodsElectronic databases (e.g., Medline, Web of Knowledge, Embase, and the Cochrane Library) were searched from their inception until May 18, 2020. Trials written in English that investigated the Peguero-Lo Presti criteria for detecting LVH were included. Data were independently extracted and analyzed by two investigators.ResultsA total of 51 records were screened, and 6 trials comprising 13,564 patients were finally included. A bivariate analysis showed that the sensitivity of the Peguero-Lo Presti criteria (0.52, 95% confidence interval (CI) 0.46-0.58) was higher than that of the Cornell voltage index (0.29, 95% CI 0.23-0.36) and Sokolow-Lyon criteria (0.24, 95% CI 0.21-0.27); the diagnostic accuracy of the Peguero-Lo Presti criteria (0.69, 95% CI 0.65-0.73) was also higher than that of the Cornell voltage index (0.67, 95% CI 0.62-0.71) and Sokolow-Lyon criteria (0.28, 95% CI 0.25-0.32); and the specificity of the Peguero-Lo Presti criteria (0.85, 95% CI 0.79-0.90) was similar to that of the Cornell voltage index (0.92, 95% CI 0.89-0.95) and Sokolow-Lyon criteria (0.94, 95%CI 0.88-0.97). Two trials (including 12,748 patients) were discharged because they included partly healthy subjects and accounted for substantial heterogeneity. Pooled analysis of the remaining 4 trials (including 816 patients) showed that the sensitivity of the Peguero-Lo Presti criteria (0.56, 95% CI 0.51-0.61) was also higher than that of the Cornell voltage index (0.36, 95% CI 0.31-0.42) and Sokolow-Lyon criteria (0.24, 95% CI 0.18-0.31); the diagnostic accuracy of the Peguero-Lo Presti criteria (0.84, 95% CI 0.80-0.87) was also higher than that of the Cornell voltage index (0.54, 95% CI 0.50-0.58) and Sokolow-Lyon criteria (0.38, 95% CI 0.34-0.42); and the specificity of the Peguero-Lo Presti criteria (0.90, 95% CI 0.87-0.92) was similar to that of the Cornell voltage index (0.93, 95% CI 0.88-0.96) and Sokolow-Lyon criteria (0.97, 95% CI 0.90-0.99). Both the likelihood ratio and posttest probability of the Peguero-Lo Presti criteria and Cornell voltage index were moderate.ConclusionBased on this systematic review and meta-analysis, the Peguero-Lo Presti criteria-based ECG diagnostic method for LVH has high sensitivity, specificity and diagnostic accuracy and should be applied in clinical practice settings.

Dataset Information

Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review.

Objective

Design

Data sources

Study selection

Data extraction

Data synthesis

Results

Conclusion

Publications

Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review.

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