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BMJ. 2007 Oct 6;335(7622):711. Epub 2007 Aug 28.

Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review.

Author information

1
Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, CH-3012 Berne, Switzerland.

Abstract

OBJECTIVE:

To review the accuracy of electrocardiography in screening for left ventricular hypertrophy in patients with hypertension.

DESIGN:

Systematic review of studies of test accuracy of six electrocardiographic indexes: the Sokolow-Lyon index, Cornell voltage index, Cornell product index, Gubner index, and Romhilt-Estes scores with thresholds for a positive test of > or =4 points or > or =5 points.

DATA SOURCES:

Electronic databases ((Pre-)Medline, Embase), reference lists of relevant studies and previous reviews, and experts.

STUDY SELECTION:

Two reviewers scrutinised abstracts and examined potentially eligible studies. Studies comparing the electrocardiographic index with echocardiography in hypertensive patients and reporting sufficient data were included.

DATA EXTRACTION:

Data on study populations, echocardiographic criteria, and methodological quality of studies were extracted.

DATA SYNTHESIS:

Negative likelihood ratios, which indicate to what extent the posterior odds of left ventricular hypertrophy is reduced by a negative test, were calculated.

RESULTS:

21 studies and data on 5608 patients were analysed. The median prevalence of left ventricular hypertrophy was 33% (interquartile range 23-41%) in primary care settings (10 studies) and 65% (37-81%) in secondary care settings (11 studies). The median negative likelihood ratio was similar across electrocardiographic indexes, ranging from 0.85 (range 0.34-1.03) for the Romhilt-Estes score (with threshold > or =4 points) to 0.91 (0.70-1.01) for the Gubner index. Using the Romhilt-Estes score in primary care, a negative electrocardiogram result would reduce the typical pre-test probability from 33% to 31%. In secondary care the typical pre-test probability of 65% would be reduced to 63%.

CONCLUSION:

Electrocardiographic criteria should not be used to rule out left ventricular hypertrophy in patients with hypertension.

PMID:
17726091
PMCID:
PMC2001078
DOI:
10.1136/bmj.39276.636354.AE
[Indexed for MEDLINE]
Free PMC Article

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