Adjustments of Electrocardiographic Criteria for the Diagnosis of Left Ventricular Hypertrophy

Accuracy of the novel Peguero Lo-Presti criterion for electrocardiographic detection of left ventricular hypertrophy in a black African population

The diagnostic accuracy of the electrocardiogram for left ventricular hypertrophy (LVH) is limited. Recently, Peguero and collaborators proposed a novel voltage criterion for its detection with reportedly higher accuracy than the commonly used Cornell and Sokolow‐Lyon criteria. While studies done in various populations have confirmed it, there are no available data from black African populations. We conducted a cross‐sectional study in a population from Cameroon to compare the Peguero‐Lo Presti criterion to the older Cornell, Sokolow‐Lyon, and Cornell product criteria, pertaining to their sensitivity, specificity, and area under the receiver operating characteristic curve (AUC), with echocardiography as the reference standard. The study population consisted of 238 participants (54.2% female) with a mean age of 58 (SD 13) years. On echocardiography, the prevalence of LVH was 45.3% (n = 108). The sensitivity was 48.14%, 63.89%, 63.89%, and 67.29% for the Sokolow‐Lyon, Peguero‐Lo Presti, Cornell, and Cornell product criteria, respectively. The specificity was 73.84%, 75.97%, 79.23%, and 82.31% for the Peguero‐Lo Presti, Cornell product, Cornell, and Sokolow‐Lyon criteria, respectively. The overall accuracy of the Peguero‐Lo Presti (AUC = 0.689) was not significantly different from that of the Cornell (AUC = 0.714), the Cornell product (AUC = 0.717), and the Sokolow‐Lyon (AUC = 0.652) (all p ˃ .05). Hypertension and gender influenced the agreement between ECG criteria and echocardiography in the detection of LVH. In conclusion, in this black African population, Peguero‐Lo Presti was not significantly more or less accurate than Cornell or Sokolow‐Lyon.

A meta-analytic evaluation of the diagnostic accuracy of the electrocardiographic Peguero-Lo Presti criterion for left ventricular hypertrophy

Although electrocardiography (ECG) is a cost-effective and convenient tool for routine screening of left ventricular hypertrophy (LVH), its performance has been shown to be poor. The Peguero-Lo Presti, a novel voltage criterion, was found to be potentially better than the most commonly used criteria. We conducted a systematic review and meta-analysis of its diagnostic accuracy compared to Cornell and Sokolow-Lyon voltage criteria. Bibliographic databases were searched to identify relevant articles. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (ROC) curves were performed for comparison. Ten studies reporting data from 5984 individuals were included in the meta-analysis. Peguero-Lo Presti had the highest pooled sensitivity (43.0%, 95% confidence interval [CI]: 30.2-56.9) followed by Cornell (26.1%; 95% CI: 16.9-37.9) and Sokolow Lyon (22.0%; 95% CI: 14.1-32.7). However, Peguero-Lo Presti had the lesser pooled specificity (90.5%; 95% CI: 86.3-93.5) and Cornell the highest (94.9%; 95% CI: 90.3-97.3). The pooled DOR was 6.63 (95% CI: 3.95-11.13), 5.50 (95% CI: 3.64-8.30), and 2.94 (95% CI: 2.20-3.92) for Peguero-Lo Presti, Cornell, and Sokolow-Lyon, respectively. Peguero-Lo Presti had the best accuracy according to summary ROC curves, with an area under the curve of 0.827 compared to 0.715 for Cornell, and 0.623 for Sokolow-Lyon. In conclusion, according to this meta-analysis, Peguero-Lo Presti has a better diagnostic performance than Cornell and Sokolow-Lyon and might be more useful in routine clinical practice as a screening tool for LVH.