Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Mar 26, 2019; 11(3): 94-102
Published online Mar 26, 2019. doi: 10.4330/wjc.v11.i3.94
Improved scoring system for the electrocardiographic diagnosis of left ventricular hypertrophy
Eric D Braunstein, Lori B Croft, Jonathan L Halperin, Steve L Liao
Eric D Braunstein, Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, NY 10467, United States
Lori B Croft, Jonathan L Halperin, Steve L Liao, Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, NY 10029, United States
Author contributions: Braunstein ED designed the project, performed data collection and statistical analysis, and drafted the manuscript; Croft LB assisted with data collection and provided critical review of the manuscript; Halperin JL provided critical review of the manuscript; Liao SL designed the project, provided study oversight, and provided critical review of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Human Research Protection Program at the Icahn School of Medicine at Mount Sinai in October 2015.
Informed consent statement: A waiver of informed consent was granted by the institutional review board due to the retrospective nature of the study, minimal risk to study subjects, and impracticality of obtaining consent from all subjects.
Conflict-of-interest statement: The authors have no relevant sources of funding or conflicts of interest to disclose.
STROBE statement: The guidelines of the STROBE Statement have been adopted for this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Steve L. Liao, MD, Assistant Professor, Division of Cardiology, Mount Sinai Medical Center, 1176 5th Avenue, New York, NY 10029, United States. steve.liao@mountsinai.org
Telephone: +1-212-4271540 Fax: +1-212-4107196
Received: November 19, 2018
Peer-review started: November 19, 2018
First decision: December 10, 2018
Revised: December 12, 2018
Accepted: December 24, 2018
Article in press: December 24, 2018
Published online: March 26, 2019
Abstract
BACKGROUND

Left ventricular hypertrophy (LVH) is a common manifestation of cardiovascular disease and a risk factor for cardiovascular morbidity and mortality, but available methods for its electrocardiographic (ECG) diagnosis have limited accuracy.

AIM

To investigate findings associated with LVH on ECG and developed an improved system for the diagnosis of LVH.

METHODS

A cohort study comparing ECG data acquired within 30 days of transthoracic echocardiography (TTE) was performed. Multivariate regression analysis identified ECG findings associated with increased LV mass and mass index. A scoring system was derived and performance compared to established criteria for LVH.

RESULTS

Data from 5486 outpatients with TTEs and corresponding ECGs were included in the derivation cohort, 333 (6.1%) of whom had LVH by TTE. In the primary regression analysis, findings associated with LVH were amplitudes of Q in V3, R in V6, S in V3, T in V6, P’ in V1, P in V6, as well as R and T-axis discordance, R peak time in V6, QRS duration, weight, height, sex, and age. From this we derived a score consisting of 5 criteria, and validated it in an independent cohort of 910 patients. With a threshold of 1.5 points, sensitivity and specificity were 67.9% and 81.4%, and 62.5% and 83.2% in the derivation and validation cohorts, respectively. With a threshold of 2 points, sensitivity and specificity were 42.3% and 93.0%, and 37.5% and 93.4% in these cohorts.

CONCLUSIONS

This score had superior sensitivity for detection of LVH by ECG while making a modest sacrifice in specificity compared to conventional criteria.

Keywords: Left ventricular hypertrophy, Electrocardiogram, Echocardiogram, Diagnostic criteria, Scoring system

Core tip: In this study we performed analysis of a large number of echocardiograms with corresponding electrocardiographic (ECG), and though multivariate regression analysis identified ECG findings associated with left ventricular hypertrophy (LVH). Using these findings, a five-item scoring system was developed to diagnose LVH on ECG. The performance characteristics of the system were compared to several conventional criteria, and it was seen to have superior sensitivity, including in an independent validation cohort. Using this scoring system, we believe that the diagnosis of LVH on ECG will be more clinically applicable in certain patient populations given the enhanced sensitivity of this test.