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KMID : 0352120190340010017
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Journal of Kyung Hee University
2019 Volume.34 No. 1 p.17 ~ p.25
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Usefulness of Electrocardiogram-based Criteria for Left Ventricular Hypertrophy in Asians Undergoing Elective Surgery: A Preliminary Investigation
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Choi Jeong-Hyun
Shin Eun-Sil
Kim Jeong-Eun
Lee Sang-Ho
Ahn Won-Sik
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Abstract
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Background and Objectives: Preoperative electrocardiography (ECG) is performed as a screening test for heart disease. Left ventricular hypertrophy (LVH) is associated with an increased risk of cardiovascular morbidity and mortality. However, the accuracy of ECG in diagnosing LVH is controversial. Therefore, it is necessary to investigate the diagnostic accuracy of conventional ECG voltage criteria in screening for LVH in patients undergoing elective surgery.
Methods: We retrospectively reviewed the electronic medical records of patients aged ≥19 years who underwent elective surgery and had both preoperative standard 12-lead resting ECG and transthoracic echocardiography. LVH was diagnosed based on the Sokolow-Lyon index. Echocardiographic diagnosis of LVH was defined as a left ventricular mass index (LVMI) > 115 g/㎡ in men and > 95 g/㎡ in women.
Results: Our study included 412 patients. LVH was diagnosed in 46 patients based on ECG criteria and in 137 patients based on echocardiographically derived LVMI. The area under the curve was 0.596 (95% confidence interval 0.51-0.69, P=0.029). The sensitivity, specificity, positive and negative predictive values, and the error rate were 41.3, 67.8, 13.9, 90.2, and 35.2%, respectively.
Conclusions: In conclusion, ECG-based criteria to diagnose LVH in Asian patients undergoing elective surgery showed low sensitivity and specificity, indicating low diagnostic accuracy of this modality. Further studies that could improve the diagnostic accuracy of an ECG could reduce the economic burden by avoiding unnecessary tests and enable accurate preoperative evaluation of patients.
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KEYWORD
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Electrocardiography, Echocardiography, Left ventricular hypertrophy
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