Published online Mar 26, 2019. doi: 10.4330/wjc.v11.i3.94
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
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.
Improvement in the ability of clinicians to diagnose LVH on ECG could aid with patient risk stratification and prevent unnecessary additional testing.
The aim of this study was to investigate findings associated with LVH on ECG and develop an improved system for the diagnosis of LVH.
A cohort study comparing ECG data acquired within 30 days of transthoracic echocardiography 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.
In 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. A score consisting of 5 criteria was derived and validated it in an independent cohort. This score had superior sensitivity for detection of LVH by ECG compared to conventional criteria whilst making a modest sacrifice in specificity compared to conventional criteria.
We identified several ECG findings that are associated with LVH and incorporated them into a score to improve the ECG diagnosis of this common condition. The scoring system may help improve clinical utility by enhancing sensitivity whilst displaying a modest sacrifice in specificity compared to conventional criteria.
Further studies are needed to determine whether this scheme optimally reflects changes in the electrical characteristics of the myocardium over time, and whether it may have value for predicting cardiovascular events that are not exposed by measurement of ventricular mass alone.