la sensibilidad y especificidad de los criterios electrocardiográficos para la hipertrofia ventricular izquierda según métodos de Romhilt-Estes, Sokolow-Lyon, . Diagnóstico de la hipertrofia ventricular izquierda por electrocardiografía: Utilidad de los nuevos criterios. Article · September with 14 Reads. Cite this . Algunos criterios ECG como Sokolow, Cornell, Gubner-Ungerleider, onda RaVL y la suma del QRS de 12 derivaciones se estudiaron no sólo en voltaje, sino.
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To determine the most sensitive criterion for the detection of left ventricular hypertrophy according to echocardiographically defined left ventricular mass. The Sokolow-Lyon voltage, Sokolow-Lyon-Rappaport, Cornell voltage duration product, White-Bock, and Romhilt-Estes point scoring criteria were compared with criteros ventricular mass index, corrected for body surface, obtained from the echocardiograms of outpatients females, malesof all age groups. The Cornell voltage duration product criteria index had the greatest sensitivity in women When applied to men critterios the same voltage amplitude 20mm as that in women, the Cornell index showed increased sensitivity relative to the conventional index 28mm of The White-Bock and Romhilt-Estes criteria were the least sensitive in men and women, despite their high specificity.
The electrocardiographic criteria were more efficient when dilatation predominated over left ventricular hypertrophy. The Cornell index had greater sensitivity in women, and the Sokolow-Lyon-Rappaport index was more sensitive in men.
When applied to men at the same voltage amplitude as that of women, the Cornell index had an increase in sensitivity similar to that of the Sokolow-Lyon-Rappaport index.
Increases in left ventricular mass have been associated with increases in the magnitude and duration of the QRS complexes 1,2. Several criteria exist for the electrocardiographic detection of left ventricular hypertrophy LVH. From the earliest times of electrocardiographic use, many indexes for the magnitude and duration of QRS complexes and AQRS have been developed. Electrocardiographic evidence of left ventricular hypertrophy is one of the most widely used markers of cardiovascular morbidity and mortality 3,4.
It has become a clinical priority to precociously detect left ventricular hypertrophy by effective, low-cost screening, applicable to the population in general Numerous publications have emphasized the need for such precocious detection, useful as an important prognostic index of LVH 9. Currently, low cost and ease of application have rendered electrocardiography the preferable means to this end.
Yet, despite their high specificity, at present electrocardiographic indexes still suffer from their low sensitivity. The present study attempts to correlate findings obtained with 5 different electrocardiographic criteria with data on left ventricular mass obtained by echocardiography. The Sokolow-Lyon voltage, Sokolow-Lyon-Rappaport, Cornell voltage duration product, White-Bock, and Romhilt-Estes point score criteria were chosen for our study because we currently use them and because of their long-standing international recognition.
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The recently developed Cornell criterion 10 has been extensively used in studies in North Criteriis. For this reason, it has been included in this correlation study. In this study, we determined the electrocardiographic criterion that had the greatest sensitivity for detecting left ventricular overload in men and women.
We then correlated age, anterior-posterior thoracic diameter, thoracic perimeter, and left ventricular mass with xriterios amplitudes used for electrocardiography. Participants were informed about the aims of the project, its approval by the Medical Ethics Committee of the Hospital, and gave their written consent to be participants in the study.
The selected cohort was consecutively obtained between March 15, and December 20, by random choice of outpatients scheduled for echocardiography. Evaluations included clinical examination, an electrocardiogram ECGand anthropometric and arterial measurements prior to echocardiography.
ECGs were numbered randomly to prevent later identification.
Comparison of the analytical results with the patient’s identity were performed only after all data had been collected. Causes for exclusion from the cohort were: A total of women, men patients were studied. Subjects less than 12 years of age included 34 females and 41 males. Eighteen men and 21 women were non-Caucasian. The patient universe comprised normal individuals and those whose echocardiograms showed increased left ventricular mass; 19 women and 21 men had undergone valve replacement mostly of the mitral valve; 5 women and 8 men had metallic prostheses.
Age, sex, race, results of the clinical examination, arterial pressure, weight, height, thoracic anterior-posterior diameter, and thoracic perimeter at the height of the fifth intercostal space were recorded.
Body mass index was determined by weight kg divided by height m 2. Body surface was obtained using the Dubois and Dubois formula Medications, especially digitalis and antiarrhythmics taken regularly, were recorded. Questions about previous cardiac surgery and valve replacement were asked. ECGs were obtained after the clinical examination. The same examiner, using a Hewlett-Packard Sonos apparatus with a 2.
Images were taken by orienting images at the two-dimensional mode on the transversal plane of the left ventricle after left parasternal positioning of the transducer at the height of the papillary muscles 6,12, ECGs and echocardiograms of each patient were taken on the same day. Electrocardiographic criteria for determining left ventricular hypertrophy were as follows: Left ventricular mass determined the echocardiographic criterion of LVH chosen All measurements were taken at the end of ventricular diastole, corresponding to the beginning of the QRS complex recorded on the simultaneously taken electrocardiographic tracing.
The second values were corrected for body surface, respectively. Mass in adults was also estimated according to the normality curve cited by Feigenbaum 17 and after the study of Abergel et al Normality criteria for left ventricular mass in children were defined by the studies of Simone et al 19 and Daniels et al 20 and were in agreement with the normality curve cited by Feigenbaum 17, Study participants were considered clinically and echocardiographically normal if they were free of alterations in the cardiac chambers, valve changes of hemodynamic significance, a transvalvular gradient detectable by color flow Doppler, had a systolic arterial pressure below mmHg and a diastolic pressure below 90mmHg, had no abnormalities on clinical examination, and were not using medication.
These normal participants were selected as examples of normality tracings of left ventricular mass, taking into consideration their sex, age, body mass index, and body surface. Cases with left ventricular mass greater than all values and curves considered as normal were considered patients with increased left ventricular mass. Left ventricular mass determined by echocardiography was considered as the gold standard, and results of this examination were accepted as the true ones.
The various results of the determinations of left ventricular hypertrophy obtained by the electrocardiographic criteria applied to each case were compared with the left ventricular mass obtained by echocardiography.
The degree of agreement in the methods was analyzed separately for male and female patients. Cases studied were analyzed after being subdivided into a group with normal and a group with increased left ventricle mass.
Standard deviation of the mean was calculated using Fisher’s statistical method. Age groups were determined according to Simone et al 19 for the population less than 18 years of age, and according to Levy et al 16 for the population aged over 18 years. Sensitivity, specificity, positive and negative predictive values of each electrocardiographic criteria and were statistically analyzed with the statistical test for 2 independent groups.
Finally, the study analyzed the relationship of the most sensitive electrocardiographic criteria with age, anterior-posterior thoracic diameter, thoracic perimeter, and left ventricular mass in the population of individuals considered normal, separated for male and female sex, to evaluate the influences of such variables on these methods.
Three hundred six subjects, 85 with increased left ventricular mass LVM based on echocardiographic findings and with normal LVM, were studied according to age, sex, body surface and body mass index.
The clinically normal population, ie, those having echocardiographically determined normal LVM, comprised 76 women and 63 men. Various population characteristics were determined from this normal subgroup. A progressive increase of LVM with aging was found Figure 1. In contrast with earlier tracings, no significant variation due to age was noted, values remaining constant in the diverse age groups Figure 2when LVM was corrected for body surface.
The study of normal subjects showed an increased LVM proportional to body mass index and body surface not presented here. Tracings of normal individuals aided in the evaluation of other members of the cohort, by determining those with increased ventricular mass. Compared with the normal members of the skolow analyzed, higher average age was observed in subjects with LVH, both male and female.
Women with LVH averaged Among men, normal individuals averaged Body mass indexes and body surface were greater in the majority of age groups having LVH xokolow with the normal group, but this difference was not significant.
Mean values of systolic or diastolic arterial pressure, cardiac frequency, anterior-posterior thoracic diameter and thoracic perimeter did not differ among normal individuals and those with LVH. The data show homogeneity in the anthropometric data, arterial blood pressure, and heart rate between individuals with or without LVH.
As shown above, this similarity did not extend to mean age.
Tables I and IIrespectively, show that in both sexes, all electrocardiographic studies had statistically significantly higher average values for the population with increased left ventricular mass in all age groups, maintaining a correlation between mean left ventricular mass measured prior to, and following, correction for body surface.
Despite this, mean values of the electrocardiographic criteria for detection of left ventricular overload in individuals with increased left ventricular mass remained below those considered maximal. Left ventricular mass was still within the range of what was considered normal by methods used even though it was still significantly higher than that in the normal group.
This result was neatly brought out by the White-Bock criteria and the point scoring of Romhilt-Estes both for males and females. The Sokolow-Lyon and Sokolow-Lyon-Rappaport criteria had higher averages in individuals with LVH among young adults, but these values decreased gradually with aging.
The Cornell criterion maintained high averages in young individuals with hypertrophy. These values also decreased gradually in older subjects, both in normal and hypertrophied women. In males, decreased average amplitudes were observed with increasing age, both in individuals with or without ventricular hypertrophy, except for a progressive increase in average amplitude based on the Cornell criterion, noted in normal subjects.
Results obtained for the correlation between electrocardiograms and echocardiograms were separated according to sex and initially described for women. The echocardiogram demonstrated increased left ventricular mass in 51 women and normal values in The Cornell criterion in women had the highest sensitivity, It also had high specificity, When this method was compared with that of the Sokolow-Lyon-Rappaport criterion, the second showed The methods were not different in specificity.
The 3 criteria had statistically significantly higher sensitivity than those of White-Bock and Romhilt-Estes. The latter had the lowest indexes of sensitivity, but the highest, statistically significant specificity, in comparison with the other three. Results obtained in men are depicted in Table IV. The high sensitivity The Sokolow-Lyon criterion had a greater sensitivity of The White-Bock and Romhilt-Estes criteria had low sensitivity but high specificity.
An analysis of electrocardiographic criteria for determining left ventricular hypertrophy
No statistically significant difference occurred for the Cornell and Sokolow-Lyon criteria. In men, the Cornell criterion had low sensitivity, compared with that in women, where it had the greatest values. Analysis of this criterion, reducing the amplitude obtained by adding the voltages of the R wave in the aVL derivation to the S wave on derivation V 3 from 28 to 24mm, as proposed by Verdecchia et al 24 and corroborated by the data obtained from the averaged amplitudes of patients with LVH at various age levels Table IIled to a reevaluation of the Cornell criterion, modified for men.
The sensitivity of the Cornell criterion modified to 24mm was Specificity of the modified criterion was The modified method had a positive predictive value of The authors of the present study proposed verifying the data with an amplitude of 20mm.