open access

Vol 19, No 6 (2012)
Original articles
Published online: 2012-12-06
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Electrocardiographic diagnosis of the left ventricular hypertrophy in patients with left bundle branch block: Is it necessary to verify old criteria?

Rafał Baranowski, Łukasz Małek, Dominika Prokopowicz, Mateusz Śpiewak, Jolanta Miśko
DOI: 10.5603/CJ.2012.0110
·
Cardiol J 2012;19(6):591-596.

open access

Vol 19, No 6 (2012)
Original articles
Published online: 2012-12-06

Abstract


Background: The diagnosis of left ventricular hypertrophy (LVH) in the presence of the left bundle branch block (LBBB) is difficult. In our study we compared commonly used ECG criteria with left ventricular mass index (LVMI) calculated during cardiac magnetic resonance imaging (CMRI) to verify their clinical value or the need to recalibrate.
Methods: CMRI and ECG data of 36 patients were included in this study. Based on the ECG measures we used in our study selected ECG criteria for LVH detection in cases with LBBB: QRS duration, amplitude of S waves in V1, V2, V3; R waves in aVL, V5, V6 and combinations of amplitudes. LVH was defined as LVMI (CMRI) exceeding reference values.
Results: LVH was diagnosed in 17 (47%) patients (6 women and 11 men). Following ECG parameters correlated the most prominently with LVMI — RV5: r = 0.5 (p = 0.002), RV6: r = 0.61 (p = 0.0001), SV1+RV5, 6: r = 0.64 (p = 0.001), RaVL+SV3: r = 0.5 (p = 0.002), SV2+RV5, 6: r = 0.71 (p = 0.0001), SV2, 3+RV5, 6: r = 0.75 (p = 0.0001). Based on the results of ROC analysis we proposed new cut points for LVH parameters. The highest diagnostic accuracy achieved S2+SV3 > 6 mV, SV2,V3+RV5,V6 > 4 mV, RaVL+SV3 > 3.5 mV (86–89%).
Conclusions: In patients with LBBB the ECG parameters based on the amplitude of S wave in V2 or V3 and R wave in the leads aVL, V5, V6 have the highest clinical value in the prediction of the LVH determined by CMRI. It was necessary to recalibrate these parameters and it is needed to verify them in larger number of LBBB patients.

Abstract


Background: The diagnosis of left ventricular hypertrophy (LVH) in the presence of the left bundle branch block (LBBB) is difficult. In our study we compared commonly used ECG criteria with left ventricular mass index (LVMI) calculated during cardiac magnetic resonance imaging (CMRI) to verify their clinical value or the need to recalibrate.
Methods: CMRI and ECG data of 36 patients were included in this study. Based on the ECG measures we used in our study selected ECG criteria for LVH detection in cases with LBBB: QRS duration, amplitude of S waves in V1, V2, V3; R waves in aVL, V5, V6 and combinations of amplitudes. LVH was defined as LVMI (CMRI) exceeding reference values.
Results: LVH was diagnosed in 17 (47%) patients (6 women and 11 men). Following ECG parameters correlated the most prominently with LVMI — RV5: r = 0.5 (p = 0.002), RV6: r = 0.61 (p = 0.0001), SV1+RV5, 6: r = 0.64 (p = 0.001), RaVL+SV3: r = 0.5 (p = 0.002), SV2+RV5, 6: r = 0.71 (p = 0.0001), SV2, 3+RV5, 6: r = 0.75 (p = 0.0001). Based on the results of ROC analysis we proposed new cut points for LVH parameters. The highest diagnostic accuracy achieved S2+SV3 > 6 mV, SV2,V3+RV5,V6 > 4 mV, RaVL+SV3 > 3.5 mV (86–89%).
Conclusions: In patients with LBBB the ECG parameters based on the amplitude of S wave in V2 or V3 and R wave in the leads aVL, V5, V6 have the highest clinical value in the prediction of the LVH determined by CMRI. It was necessary to recalibrate these parameters and it is needed to verify them in larger number of LBBB patients.
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Keywords

ECG; left bundle branch block; left ventricular hypertrophy; cardiac magnetic resonance imaging

About this article
Title

Electrocardiographic diagnosis of the left ventricular hypertrophy in patients with left bundle branch block: Is it necessary to verify old criteria?

Journal

Cardiology Journal

Issue

Vol 19, No 6 (2012)

Pages

591-596

Published online

2012-12-06

DOI

10.5603/CJ.2012.0110

Bibliographic record

Cardiol J 2012;19(6):591-596.

Keywords

ECG
left bundle branch block
left ventricular hypertrophy
cardiac magnetic resonance imaging

Authors

Rafał Baranowski
Łukasz Małek
Dominika Prokopowicz
Mateusz Śpiewak
Jolanta Miśko

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