Author + information
- Peter W. Macfarlane, DSc∗ (, )
- Elaine N. Clark, MA and
- John G.F. Cleland, MB, ChB, MD, PhD
- ↵∗Electrocardiology Section, Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow Royal Infirmary, 10 Alexandra Parade, Glasgow, G31 2ER, United Kingdom
The recent paper by Peguero et al. (1) set out new criteria for the electrocardiographic (ECG) diagnosis of left ventricular hypertrophy (LVH), namely (max Samp + SV4 amp) ≥2.8 mV and 2.3 mV in male and female patients, respectively. However, these Peguero-Lo Presti criteria were developed and assessed from the ECGs of 94 patients in a test group and 122 patients in a validation group with mean ages of 54 ± 17 years and 68 ± 15 years, respectively.
Sex-dependent criteria for the ECG diagnosis of LVH are appropriate, but such criteria should also be age dependent (2). Accordingly, we evaluated the specificity of these new criteria as well as those of Sokolow-Lyon (2) and Cornell (2) using our database comprising ECGs from 859 male and 637 female apparently healthy individuals between 18 and 82 years of age (2). All ECGs were analyzed by the University of Glasgow ECG analysis program (3).
The prevalence of LVH using the Peguero-Lo Presti criteria was much higher than using other criteria (Table 1), especially in younger people and men. A similar pattern can be seen in the Sokolow and Lyon criteria. However, the Cornell criteria remain specific at all age and sex ranges.
This study underlines the fact that ECG criteria for LVH must be age and sex specific. Our own data suggest that thresholds for the new Peguero-Lo Presti measure for male and female patients younger than age 40 years should be 4.2 mV and 3.14 mV, respectively, to give a specificity of 95% in this age group. It is not possible to comment on sensitivity. Ideally, criteria should also be race dependent, as we have suggested previously (4).
New criteria for LVH require careful evaluation of their performance across a large sample of individuals of both sexes with a wide age range.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2017 American College of Cardiology Foundation
- Peguero J.G.,
- Lo Presti S.,
- Perez J.,
- Issa O.,
- Brenes J.C.,
- Tolentino A.
- Macfarlane P.W.,
- van Oosterom A.,
- Pahlm O.,
- Kligfield P.,
- Janse M.,
- Camm J.
- Macfarlane P.W.,
- Devine B.,
- Clark E.