A systemic review of 4 ECG left ventricular hypertrophy criteria: Peguero-Lo Presti, Cornell criteria, Sokolow-Lyon, and Romhilt-Estes: Which one has the better diagnostic performance?

Tóm tắt

Background

Left ventricular hypertrophy (LVH) is a pathological condition characterized by the enlargement and thickening of the walls of the left ventricle, resulting in increased pressure and impaired pumping function. It commonly occurs in individuals with hypertension and valvular heart disease. Detecting LVH in a timely manner and accurately assessing its severity are essential for effective management.

Electrocardiography (ECG) is a widely accessible, cost-effective, and non-invasive method commonly employed for initial LVH detection. Currently, there are 37 ECG criteria for LVH acknowledged by the American Heart Association. Four of the more widely used criteria are Cornell Voltage (CV), Peguero-Lo Presti (PLP), Romhilt-Estes (RE), and Sokolow- Lyon (SL). In this study, we aim to assess the sensitivity and specificity of the four most commonly utilized criteria. The findings of this review will help clinicians in selecting the most appropriate ECG criteria for accurate LVH detection and guide future research to refine LVH diagnostic algorithms.

Methods

Literature searches were done in 4 databases which are Pubmed, Embase, PMC, and Cochrane Library through 2023 April 20. To ensure sensitivity, keywords of “Cornell Voltage AND Sokolow-Lyon Voltage AND Peguero-Lo Presti AND Romhilt-Estes AND Left Ventricular Hypertrophy” were used. We included all cross-sectional studies investigating adult patient (≥ 18 years old)  for Left Ventricular Hypertrophy, studies using Peguero-Lo Presti, Cornell Voltage, Sokolow-Lyon, and Romhilt-Estes as LVH ECG criterias, studies using echocardiography as the  gold-standard diagnostic evaluation using Devereux formula to calculate Left Ventricular Mass (LVM).  Studies with topics irrelevant to clinical question, articles without available full-text, and studies with language other than English were excluded from this review. Two reviewers conducted the process independently. The assessment tool to evaluate study quality was QUADAS-2. The assessment process was conducted by 2 independent reviewers followed by a cross checking process. Any different results were then resolved through discussion to reach a consensual agreement.

For data extraction, The number of true positive (TP), false positive (FP), true negative (TN), and false negative (FN) patients were extracted by two independent reviewers. Each reviewer then cross checked the result to prevent any errors. The extracted datas were then analysed for meta analysis using Stata-MP-64.

Results

Four high to moderately-high quality studies were included in the study (Figure 1 and 2). The study characteristics are specified in Table 1. We found that The sensitivity and specificity in detecting LVH was highest using PLP criteria (45,2%) and CV criteria (92,4%) subsequently (Table 2).

Conclusion

In conclusion, ECG is a poor tool for LVH screening due to its low sensitivity. However, in limited settings, our findings suggest that among the four criteria, PLP and CV criteria exhibit superiority over RE and SL criteria in detecting left ventricular hypertrophy through ECG analysis.