ECHO Criteria for LVH Clarified in Jamaican Adults

Brian Hoyle

doi:10.1177/155989771424002

Summary

This article discusses a study that has clarified the diagnosis of left ventricular hypertrophy (LVH) in Jamaican adults. LVH, which is frequent in patients with hypertension, can increase the risk for cardiovascular disease. LVH has been diagnosed by echocardiography (ECHO) in patients with normal results on electrocardiography (ECG). Although ECHO is more accurate at diagnosing LVH, it is not always readily accessible. On the other hand, ECG, which is widely available, often does not correlate with ECHO findings.

Cardiology Clinical Trials
Imaging Modalities
Valvular Disease
Cardiac Imaging Techniques

Cardiology & Cardiovascular Medicine
Cardiology Clinical Trials
Imaging Modalities
Valvular Disease
Cardiac Imaging Techniques

Kurlene Cenac, MD, Instituto Superior de Ciencias Médicas, Santa Clara, Cuba, discussed a study that has clarified the diagnosis of left ventricular hypertrophy (LVH) in Jamaican adults. LVH, which is frequent in patients with hypertension, can increase the risk for cardiovascular disease. LVH has been diagnosed by echocardiography (ECHO) in patients with normal results on electrocardiography (ECG). ECHO uses transthoracic or transesophageal ultrasonography to measure the left ventricular end-diastolic diameter, posterior wall thickness, and interventricular septal thickness. Although ECHO is more accurate at diagnosing LVH, it is not always readily accessible. On the other hand, ECG, which is widely available, often does not correlate with ECHO findings.

The study was undertaken to evaluate the agreement between LVH detected using ECG and ECHO, assess the association between symptoms defined by New York Heart Association (NYHA) functional class and LVH detected by ECG or ECHO, assess ECG and clinical characteristics that predict ECHO-apparent diastolic dysfunction, and assess the sensitivity, specificity, and positive predictive value (PPV) of established criteria for LVH detection (Table 1).

View this table:

Table 1.

Diagnostic Criteria for LVH^{^a}

The cross-sectional study assessed ECG and ECHO data from 161 patients (57 men, 104 women; 94% black) aged 21 to 80 years who underwent ECG and ECHO at 2 health centers in Jamaica from July to October 2013. On the basis of body mass index, 35% of the participants were underweight or normal weight (< 19–24.9 kg/m²), 34% were overweight (25–29.9 kg/m²), and 31% were obese or morbidly obese (≥ 30 kg/m²). Except for hypertension, the prevalence of preexisting conditions was low. NYHA classes I, II, III, and IV comprised 80, 43, 16, and 22 participants, respectively.

ECG had low sensitivity and higher specificity in the detection of LVH. The Sokolow-Lyon criteria were the most sensitive for detecting LVH (44%), followed by the Romhilt-Estes (37%), Cornell (30%), and Framingham (25%) criteria. The Framingham criteria were most specific (97%), followed by the Romhilt-Estes (92%), Cornell (93%), and Sokolow-Lyon (83%) criteria. The presence of LVH according to the ECG criteria and ECHO varied, with the latter being superior (Figure 1).

Figure 1.

Presence of Left* Ventricular Hypertrophy on ECG and ECHO.

ECG=electrocardiography; ECHO=echocardiography. Reproduced with permission from K Cenac, MD.*On November 12, 2014, Left was inserted in this figure title.

The Framingham criteria had the highest PPV, followed by the Romhilt-Estes, Cornell, and Sokolow-Lyon criteria (Figure 2).

Figure 2.

Positive Predictive Value of ECG Criteria for Left Ventricular Hypertrophy.

Reproduced with permission from K Cenac, MD.

ECHO detection of LVH did not differ appreciably by sex or age. Age was more influential for ECG-based detection of LVH with the Sokolow-Lyon and Romhilt-Estes criteria.

Study limitations included the limited patient pool, inability to reach a target sample size that would be representative given the estimated 18% prevalence of LVH in Jamaican adults, and difficulty in standardizing the ECHO procedure among the participating institutions. Nevertheless, the results indicate that everyday clinical practice could benefit from the use of other criteria, such as the Framingham criteria, in LVH screening.

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