Accuracy of ECG left ventricular hypertrophy (LVH) criteria compared to echocardiographic LVH among hypertensives in an African population

Abstract

Objectives: Hypertension remains one of the important risk factors for cardiovascular diseases and a major global public health problem. The left ventricular hypertrophy is a recognized complication of systemic hypertension and strongly predicts cardiovascular morbidity and mortality. In Nigeria, few studies have evaluated the accuracy of multiple electrocardiography (ECG) criteria in the diagnosis of the left ventricular hypertrophy among hypertensives. This study sets out to determine ECG criterion or criteria that define most accurately echocardiographic left ventricular hypertrophy (LVH) among patients with hypertension in a tertiary health institution in Nigeria. Materials and Methods: One hundred and seventy-eight hypertensives and 89 age- and sex-matched controls were recruited consecutively into the study. All participants including hypertensives and control subjects had echocardiography whereas only hypertensive subjects had both echocardiography and ECG. ECG LVH was determined using various ECG criteria. Results: The various ECG criteria for diagnosis of LVH were lower in sensitivities (23.5–38.6%) compared to specificities (64.1–72.9%). The sensitivities and specificities were 28.9% and 64.0%, 38.6% and 72.9%, 23.5% and 64.1%, 34.6% and 69.4%, 34.4% and 68.0%, and 38.6% and 72.9% for Sokolow-Lyon, Cornell voltage, Romhilt-Estes, Cornell duration product, Goldberger, and Massoleini criteria, respectively. The areas under the various receiver operating characteristic (ROC) curves were 0.7010, 0.6040, 0.5960, 0.5950, 0.4790, and 0.4660 for Sokolow-Lyon, Cornell voltage, Massoleini, Romhilt-Estes, Goldberger, and Cornell product duration criteria, respectively. Conclusion: Cornell voltage, Sokolow-Lyon, and Massoleini ECG criteria had the highest combination of sensitivities and specificities with the highest ROC values and thus most accurate ECG LVH criteria