Seamens’ Sign: a novel electrocardiogram prediction tool for left ventricular hypertrophy

Author:

Walker Philip1,Jenkins Cathy A.2,Hatcher Jeremy3,Freeman Clifford1,Srica Nickolas1,Rosell Bryant1,Hanna Eriny1,March Cooper3,Seamens Charles1,Storrow Alan1,McCoin Nicole1

Affiliation:

1. Department of Emergency Medicine, Vanderbilt University, Nashville, TN, United States of America

2. Department of Biostatistics, Vanderbilt University, Nashville, TN, United States of America

3. School of Medicine, Vanderbilt University, Nashville, TN, United States of America

Abstract

Introduction Patients with left ventricular hypertrophy (LVH) diagnosed by electrocardiogram (ECG) have increased mortality and higher risk for life-threatening cardiovascular disease. ECGs offer an opportunity to identify patients with increased risk for potential risk-modifying therapy. We developed a novel, quick, easy to use ECG screening criterion (Seamens’ Sign) for LVH. This new criterion was defined as the presence of QRS complexes touching or overlapping in two contiguous precordial leads. Methods This study was a retrospective chart review of 2,184 patient records of patients who had an ECG performed in the emergency department and a transthoracic echocardiogram performed within 90 days. The primary outcome was whether Seamens’ Sign was noninferior in confirming LVH compared to other common diagnostic criteria. Test characteristics were calculated for each of the LVH criteria. Inter-rater agreement was assessed on a random sample using Cohen’s Kappa. Results Median age was 63, 52% of patients were male and there was a 35% prevalence of LVH by transthoracic echocardiogram (TTE). Nine percent were positive for LVH on ECG based on Seamens’ Sign. Seamens’ Sign had a specificity of 0.92. Tests assessing noninferiority indicated Seamens’ Sign was non-inferior to all criteria (p < 0.001) except for Cornell criterion for women (p = 0.98). Seamens’ Sign had 90% (0.81–1.00) inter-rater agreement, the highest of all criteria in this study. Conclusion When compared to both the Sokolow-Lyon criteria and the Cornell criterion for men, Seamens’ Sign is noninferior in ruling in LVH on ECG. Additionally, Seamens’ Sign has higher inter-rater agreement compared to both Sokolow-Lyon criteria as well as the Cornell criteria for men and women, perhaps related to its ease of use.

Publisher

PeerJ

Subject

General Agricultural and Biological Sciences,General Biochemistry, Genetics and Molecular Biology,General Medicine,General Neuroscience

Reference17 articles.

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3. Left ventricular hypertrophy by the surface ECG;Bacharova;Journal of Electrocardiology,2017

4. Effect of changes in left ventricular anatomy and conduction velocity on the QRS voltage and morphology in left ventricular hypertrophy: a model study;Bacharova;Journal of Electrocardiology,2010

5. Competing cardiovascular outcomes associated with electrocardiographic left ventricular hypertrophy: the atherosclerosis risk in communities study;Desai;Heart,2012

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