Diagnostic performance of electrocardiographic criteria for left ventricular hypertrophy in hypertensive patients: a comparative analysis against echocardiography.
DOI:
https://doi.org/10.62059/rj9q7m20Keywords:
Arterial hypertension, Left ventricular hypertrophy, Electrocardiogram, Diagnostic performanceAbstract
Introduction: Left ventricular hypertrophy (LVH) is a complication of hypertension associated with increased cardiovascular risk. Objective: To determine the prevalence of LVH using different electrocardiographic criteria and evaluate their diagnostic performance in outpatient hypertensive patients. Materials and Methods: An observational, analytical, cross-sectional study was conducted in 246 adult patients with arterial hypertension attending outpatient care in 2024. The electrocardiographic criteria analyzed included Sokolow–Lyon, Cornell, Peguero Lo-Presti, and Romhilt–Estes. LVH was defined by echocardiography using the left ventricular mass index as the reference standard. Sensitivity, specificity, predictive values, accuracy, area under the curve (AUC), and p-values were calculated, along with stratified analyses according to clinical variables. Results: The prevalence of LVH by echocardiography was 39%, while ECG-based prevalence ranged from 13.4% to 19.9%. The Romhilt–Estes criterion showed the best performance, with a sensitivity of 42%, specificity of 94%, and an AUC of 0.687. The remaining criteria demonstrated lower sensitivities (21%–35%) and inferior AUC values (0.569–0.634). All criteria showed a significant association with LVH (p ≤ 0.003). Diagnostic performance varied according to sex, body mass index, and blood pressure control. Conclusions: ECG shows low sensitivity but high specificity for detecting LVH, with limited discriminative ability. The Romhilt–Estes criterion demonstrated the best overall performance. ECG is useful for initial risk stratification but does not replace echocardiography.References
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