Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2012;65:38-46 - Vol. 65 Num.01 DOI: 10.1016/j.rec.2011.07.017

Diagnostic Accuracy of Computer-Assisted Electrocardiography in the Diagnosis of Left Ventricular Hypertrophy in Left Bundle Branch Block

Luis Rodríguez-Padial a,, Blanca Rodríguez-Picón a, Miguel Jerez-Valero a, Julio Casares-Medrano a, Finn O. Akerström a, Alberto Calderon b, Vivencio Barrios c, Antonio Sarría-Santamera d, José R. González-Juanatey e, Antonio Coca f, Josep Andrés g, Jessica Ruiz-Baena g

a Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain
b CS Rosa Luxemburgo, Madrid, Spain
c Servicio de Cardiología, Hospital Ramón y Cajal, Madrid, Spain
d Agencia de Evaluación Sanitaria, Instituto de Salud Carlos III, Madrid, Spain
e Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
f Unidad de Hipertensión, Servicio de Medicina Interna, Instituto de Medicina y Dermatología, Hospital Clínico (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
g Área de investigación aplicada, GOC, Barcelona, Spain

Keywords

Electrocardiography. Hypertrophy. Left bundle branch block. Computer-assisted interpretation.

Abstract

Introduction and objectives

Left ventricular hypertrophy has important prognostic implications. Although electrocardiography is the technique most often recommended in the diagnosis of hypertrophy, its diagnostic accuracy is hampered in the presence of a left bundle branch block.

Methods

In 1875 consecutive patients (56±16 years) undergoing studies to rule out heart disease and/or hypertension, 2-dimensional echocardiography and electrocardiography were performed simultaneously in an outpatient clinic. Digitized electrocardiograms were interpreted using an online computer-assisted platform (ELECTROPRES). Sensitivity, specificity, likelihood ratios, and predictive values of standard electrocardiographic criteria and of some diagnostic algorithms for left ventricular hypertrophy were determined and compared with the findings in patients with neither left bundle branch block nor myocardial infarction.

Results

Left bundle branch block was present in 233 (12%) patients. Left ventricular hypertrophy was detected more frequently in patients with left bundle branch block (60% vs 31%). In patients with left bundle branch block, sensitivities were low but similar to those observed in patients without it, and ranged from 6.4% to 70.9%, whereas specificities were high, ranging from 57.6% to 100%. Positive likelihood ratios ranged from 1.33 to 4.94, and negative likelihood ratios from 0.50 to 0.98. Diagnostic algorithms, voltage-duration products, and certain compound criteria had the best sensitivities.

Conclusions

Left ventricular hypertrophy can be diagnosed in the presence of left bundle branch block with an accuracy at least similar to that observed in patients without this conduction defect. Computer-assisted interpretation of the electrocardiogram may be useful in the diagnosis of left ventricular hypertrophy as it enables the implementation of more accurate algorithms.

1885-5857/© 2012 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

Cookies
x
To improve our services and products, we use cookies (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.
Cookies policy
x
To improve our services and products, we use cookies (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.