Author + information
- Jay Ramchand, MBBS, BMedSci,
- Thalys Sampaio Rodrigues,
- Leighton G. Kearney, MBBS, BMedSci, PhD,
- Sheila K. Patel, BSc, PhD,
- Piyush M. Srivastava, MBBS and
- Louise M. Burrell, MBChB, MD∗ ()
- ↵∗Department of Medicine, Austin Health, University of Melbourne, Level 7, Lance Townsend Building, 145 Studley Road, Heidelberg, Victoria 3084, Australia
Peguero et al. (1) have described new electrocardiographic (ECG) criteria (the SD + SV4 –Peguero-Lo Presti) for the diagnosis of left ventricular hypertrophy (LVH), which improved the sensitivity and accuracy of the test. We addressed 2 outstanding issues with regard to the new criteria in patients at risk of LVH due to aortic stenosis (AS). First, we assessed its ability to predict all-cause mortality. Second, we tested its performance against LVH measured using cardiac magnetic resonance (CMR). Patients were prospectively recruited for an ECG and echocardiogram (n = 138), and a subset also had CMR (n = 41). All analyses were reviewed by 2 investigators blinded to other imaging results or clinical outcomes.
The mean age was 74 ± 11 years, 61% were men, and comorbidities were common (hypertension, 80%; diabetes, 25%; heart failure, 31%; coronary artery disease, 38%). On echocardiography, AS was severe in 52%, moderate in 24%, and mild in 24%. Echocardiographic-LVH (defined according to American Society for Echocardiography guidelines) was present in 81 (59%) patients. The Peguero-Lo Presti LVH criteria had nominally the best sensitivity (49%; 95% confidence interval [CI]: 39% to 60%) and specificity (84%; 95% CI: 73% to 91%), followed by the Cornell criteria (sensitivity: 26% [95% CI: 18% to 36%]; specificity: 82% [95% CI: 71% to 90%]) and Sokolow-Lyon criteria (sensitivity: 14% [95% CI: 8% to 23%]; specificity: 93% [95% CI: 83% to 97%]) (all p < 0.001, McNemar test). All-cause mortality was increased in those with Peguero-Lo Presti LVH (Figure 1). On Cox regression, after adjustment for age, coronary artery disease, and heart failure, Peguero-Lo Presti LVH was an independent predictor of all-cause mortality (hazard ratio: 4.2; 95% CI: 1.1 to 16.4; p = 0.036).
We then tested the diagnostic utility of the Peguero-Lo Presti criteria against CMR-LVH. Again, the Peguero-Lo Presti LVH criteria had nominally the best sensitivity (48%; 95% CI: 31% to 66%) and specificity (92%; 95% CI: 65% to 99%); followed by the Cornell criteria (sensitivity: 24% [95% CI: 12% to 42%]; specificity: 92% [95% CI: 65% to 99%]) and Sokolow-Lyon criteria (sensitivity: 17% [95% CI: 8% to 35%]; specificity: 100% [95% CI: 76% to 100%]) (all p < 0.001, McNemar test).
In summary, in patients with AS, the Peguero-Lo Presti criteria is a more sensitive method to diagnose both echocardiographic-LVH and CMR-LVH compared with existing ECG criteria. We report for the first time that the Peguero-Lo Presti LVH criteria predicts all-cause mortality. We agree with Peguero et al. (1) that the SD + SV4-Peguero-Lo Presti criteria is a very useful addition to our diagnostic strategies in patients at risk of LVH.
Please note: Dr. Ramchand is supported by a postgraduate scholarship cofunded by the National Heart Foundation of Australia and National Health & Research Medical Council. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. P. K. Shah, MD, served as Guest Editor-in-Chief for this paper. Kalyanam Shivkumar, MD, PhD, served as Guest Editor for this paper.
- 2017 American College of Cardiology Foundation