S. Arunkumar, V. Sakthivel, K. Kishan Raj
BACKGROUND In routine clinical practice, the electrocardiogram (ECG) is usually the first method used for diagnosing LVH using various criteria. These ECG criteria generally had shown high specificities and low sensitivity in diagnosing LVH. However, their low sensitivities do not mean that it excludes the presence of LVH. The aim of this study was to assess the validity of ECG by comparing it with echocardiogram in diagnosing LVH among hypertension patients. MATERIALS AND METHODS A prospective longitudinal study was conducted at our hospital for a period of six months among 100 patients with hypertension. The study was started after getting the clearance from the institutional ethical committee. Twelve lead electrocardiography was done with GE electrocardiogram machine. Twelve leads electrocardiography was recorded at the paper speed of 25 mm/second and calibration of 10mm was taken as a standard electrocardiogram. Electrocardiographic criteria used to diagnose left ventricular hypertrophy were Romhilt – Estes Point Score and Sokolow and Lyon Voltage Criteria and total QRS voltage criteria. Later, on all these patients, M-mode echocardiography was performed using Esoate Mylab Five machine. Person performing Echo was blinded to electrocardiographic findings. RESULTS The validity of the various ECG criteria in diagnosing LVH in comparison with echocardiogram shows that all the validity parameters like sensitivity, specificity, positive predictive value, negative predictive value and accuracy was found to be high for total QRS criteria than that of Sokolow-Lyon and Romhilt Estes criteria and the difference was also found to be statistically significant. The correlation r value was found to be equal to or less than 0.5 for Sokolow-Lyon and Romhilt Estes criteria, whereas for total QRS the R value was greater than 0.6 but for none of the criteria the P value was found to be statistically significant. CONCLUSION Echocardiography is definitely a better tool in the detection of left ventricular hypertrophy. However, improved criteria like total QRS voltage can still be adopted for the detection of LVH at a primary healthcare level.
