Accuracy of Peguero-Lo Presti ECG Criteria for Left Ventricular Hypertrophy Diagnosis in Elderly Thai Patients Using Cardiovascular Magnetic Resonance as a Gold Standard

Abstract

Background: The conventional electrocardiogram (ECG) criteria have shown low sensitivity for LVH detection in the elderly. Objective: To evaluate the diagnosis accuracy of the new ECG criteria proposed by Peguero-Lo Presti in this population using cardiovascular magnetic resonance (CMR) as a gold standard. Materials and Methods: Patients older than 60 years that underwent CMR (1.5 T and 3 T, Philips) between 2012 and 2019 were included. Exclusion criteria were abnormal CMR findings and abnormal baseline ECG. Left ventricular mass index (LVMI) was calculated from short-axis slices covering the entire left ventricle. LVH was defined as LVMI of 63 g/m² or more in male patients and 48 g/m² or more in female patients. LVH by new ECG criteria was defined by the deepest S + SV4 of 2.8 or more in males and 2.3 or more in females. Sensitivity, specificity, and accuracy between the new criteria and the Cornell voltage criteria were compared. Results: Five hundred fifty-nine patients were included with a mean age of 71±7 years old, and with 63.69% of female, 71.56% had hypertension, and 16.46% were octogenarian. Eighty patients (14.3%) had LVH detected by CMR. The new ECG criteria showed higher sensitivity compared with the Cornell voltage criteria especially in the octogenarian with a sensitivity of 15% versus 10% in overall and 31.25% versus 18.75% in octogenarian, but the AUC did not show significant difference at AUC of 0.56 versus 0.54 (p=0.67). Conclusion: Using CMR as the gold standard, the new ECG criteria showed higher sensitivity than the Cornell voltage criteria, especially in the octogenarian, without significant different accuracy. Keywords: Electrocardiography; Elderly population; Left ventricular hypertrophy; Cardiac magnetic resonance; Peguero-Lo Presti Criteria