Accuracy of Peguero-Lo Presti ECG Criteria for Left Ventricular Hypertrophy Diagnosis in Elderly Thai Patients Using Cardiovascular Magnetic Resonance as a Gold Standard
{"title":"Accuracy of Peguero-Lo Presti ECG Criteria for Left Ventricular Hypertrophy Diagnosis in Elderly Thai Patients Using Cardiovascular Magnetic Resonance as a Gold Standard","authors":"","doi":"10.35755/jmedassocthai.2023.02.13773","DOIUrl":null,"url":null,"abstract":"Background: The conventional electrocardiogram (ECG) criteria have shown low sensitivity for LVH detection in the elderly.\n\nObjective: To evaluate the diagnosis accuracy of the new ECG criteria proposed by Peguero-Lo Presti in this population using cardiovascular magnetic resonance (CMR) as a gold standard.\n\nMaterials and Methods: Patients older than 60 years that underwent CMR (1.5 T and 3 T, Philips) between 2012 and 2019 were included. Exclusion criteria were abnormal CMR findings and abnormal baseline ECG. Left ventricular mass index (LVMI) was calculated from short-axis slices covering the entire left ventricle. LVH was defined as LVMI of 63 g/m² or more in male patients and 48 g/m² or more in female patients. LVH by new ECG criteria was defined by the deepest S + SV4 of 2.8 or more in males and 2.3 or more in females. Sensitivity, specificity, and accuracy between the new criteria and the Cornell voltage criteria were compared.\n\nResults: Five hundred fifty-nine patients were included with a mean age of 71±7 years old, and with 63.69% of female, 71.56% had hypertension, and 16.46% were octogenarian. Eighty patients (14.3%) had LVH detected by CMR. The new ECG criteria showed higher sensitivity compared with the Cornell voltage criteria especially in the octogenarian with a sensitivity of 15% versus 10% in overall and 31.25% versus 18.75% in octogenarian, but the AUC did not show significant difference at AUC of 0.56 versus 0.54 (p=0.67).\n\nConclusion: Using CMR as the gold standard, the new ECG criteria showed higher sensitivity than the Cornell voltage criteria, especially in the octogenarian, without significant different accuracy.\n\nKeywords: Electrocardiography; Elderly population; Left ventricular hypertrophy; Cardiac magnetic resonance; Peguero-Lo Presti Criteria","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":"34 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.35755/jmedassocthai.2023.02.13773","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The conventional electrocardiogram (ECG) criteria have shown low sensitivity for LVH detection in the elderly.
Objective: To evaluate the diagnosis accuracy of the new ECG criteria proposed by Peguero-Lo Presti in this population using cardiovascular magnetic resonance (CMR) as a gold standard.
Materials and Methods: Patients older than 60 years that underwent CMR (1.5 T and 3 T, Philips) between 2012 and 2019 were included. Exclusion criteria were abnormal CMR findings and abnormal baseline ECG. Left ventricular mass index (LVMI) was calculated from short-axis slices covering the entire left ventricle. LVH was defined as LVMI of 63 g/m² or more in male patients and 48 g/m² or more in female patients. LVH by new ECG criteria was defined by the deepest S + SV4 of 2.8 or more in males and 2.3 or more in females. Sensitivity, specificity, and accuracy between the new criteria and the Cornell voltage criteria were compared.
Results: Five hundred fifty-nine patients were included with a mean age of 71±7 years old, and with 63.69% of female, 71.56% had hypertension, and 16.46% were octogenarian. Eighty patients (14.3%) had LVH detected by CMR. The new ECG criteria showed higher sensitivity compared with the Cornell voltage criteria especially in the octogenarian with a sensitivity of 15% versus 10% in overall and 31.25% versus 18.75% in octogenarian, but the AUC did not show significant difference at AUC of 0.56 versus 0.54 (p=0.67).
Conclusion: Using CMR as the gold standard, the new ECG criteria showed higher sensitivity than the Cornell voltage criteria, especially in the octogenarian, without significant different accuracy.
Keywords: Electrocardiography; Elderly population; Left ventricular hypertrophy; Cardiac magnetic resonance; Peguero-Lo Presti Criteria