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Usefulness of Electrocardiogram-based Criteria for Left Ventricular Hypertrophy in Asians Undergoing Elective Surgery: A Preliminary Investigation

경희의학 2019년 34권 1호 p.17 ~ 25
 ( Choi Jeong-Hyun ) - Kyung Hee University College of Medicine Department of Anesthesiology and Pain Medicine

신은실 ( Shin Eun-Sil ) - Kyung Hee University College of Medicine Department of Anesthesiology and Pain Medicine
김정은 ( Kim Jeong-Eun ) - Kyung Hee University College of Medicine Department of Anesthesiology and Pain Medicine
이상호 ( Lee Sang-Ho ) - Kyung Hee University College of Medicine Department of Anesthesiology and Pain Medicine
안원식 ( Ahn Won-Sik ) - Kyung Hee University Medical Center Blood Flow Data Center

Abstract


Background and Objectives: Preoperative electrocardiography (ECG) is performed as a screening test for heart disease. Left ventricular hypertrophy (LVH) is associated with an increased risk of cardiovascular morbidity and mortality. However, the accuracy of ECG in diagnosing LVH is controversial. Therefore, it is necessary to investigate the diagnostic accuracy of conventional ECG voltage criteria in screening for LVH in patients undergoing elective surgery.

Methods: We retrospectively reviewed the electronic medical records of patients aged ≥19 years who underwent elective surgery and had both preoperative standard 12-lead resting ECG and transthoracic echocardiography. LVH was diagnosed based on the Sokolow-Lyon index. Echocardiographic diagnosis of LVH was defined as a left ventricular mass index (LVMI) > 115 g/㎡ in men and > 95 g/㎡ in women.

Results: Our study included 412 patients. LVH was diagnosed in 46 patients based on ECG criteria and in 137 patients based on echocardiographically derived LVMI. The area under the curve was 0.596 (95% confidence interval 0.51-0.69, P=0.029). The sensitivity, specificity, positive and negative predictive values, and the error rate were 41.3, 67.8, 13.9, 90.2, and 35.2%, respectively.

Conclusions: In conclusion, ECG-based criteria to diagnose LVH in Asian patients undergoing elective surgery showed low sensitivity and specificity, indicating low diagnostic accuracy of this modality. Further studies that could improve the diagnostic accuracy of an ECG could reduce the economic burden by avoiding unnecessary tests and enable accurate preoperative evaluation of patients.

키워드

Electrocardiography; Echocardiography; Left ventricular hypertrophy
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