Validation of a new LVH ECG criterion in a single center wide population

Background and Objectives: ECG criteria for the diagnosis of left ventricular hypertrophy (LVH) have shown heterogeneity in terms of sensitivity and specificity, the current ECG recommendations count more than 35 LVH criteria. This study tested the predictivity of current major LVH criteria and compared with the recently published Peguero and LoPresti index that demonstrated an improved predictiveness. The authors also analyzed the results with different amplitudes and R-S waves combinations and try to improve the diagnostic value for LVH. Methods: all consecutive patients underwent to ECG and Echo were collected. All ECG traces were measured in terms of R and S waves amplitude QRS was also measures. The diagnosis of LVH from the echocardiography was accomplished with Devereux formula. The authors chose the Sokolow-Lyon, the Cornel and the new published LVH criterion by Peguero and LoPresti as already well described. Given the diagnosis of LVH with echocardiogram, the three ECG measurements were compared and the sensitivity and specificity was calculated for each of them. The ECG was also analyzed (R and S amplitude in different leads and QRS duration) to find a tailored algorithm to predict LVH with a better sensitivity and acceptable specificity. Results: a total of 1465 patients were collected, RBBB and LBBB, fascicular blocks were excluded a total of 1166 patients (44,6% males) were analyzed for LVH. Sokolow-Lyon criteria has predicted LVH on Echocardiography with a sensitivity of 23% and a specificity of 51%, Cornel Voltage criteria showed 23% of sensitivity and 48% specificity. The Peguero-LoPresti index has been found a 31% sensitivity and 48% specificity. Different R and S waves amplitudes had matched each other to find a better LVH predictive value compared with the best LVH index by Peguero-LoPresti, also different cutoff was analyzed to improve the LVH predictivity of the index. No R/S waves combinations or different amplitude cut off showed a better predictivity for LVH than Peguero-LoPresti index. Conclusion: the Peguero-LoPresti index has been validated in our population as the best index compared with the Sokolow-Lyon and Cornell Voltage. No other combinations showed a better predictivity for LVH in this single center population.