S_D+SV₄ Diagnosis Of Left Ventricular Hypertrophy,a Revaluation Of ECG Criteria By Cardiac Magnetic Resonance Imaging

Background:The currently accepted electrocardiographic criterias of left ventricular hypertrophy?LVH?have low sensitivity or complicated operations and were difficult to be widely used in clinical practice.In 2017American authoritative magazine——JACC,Peguero and Lo Presti proposed a new ECG diagnosis method——Peguero–Lo Presti criteria.It is simple and has good accuracy which is considered to be innovative.In addition,the average ejection fractions of the experimental and control groups in the study by Peguero et al.were 59±8%and 58±13%,respectively,which did not fully demonstrate that this criterion is applicable to people with reduced ejection fraction.Objective:Using a gold standard for the diagnosis of LVH——cardiac magnetic resonance imaging?CMR?,to evaluate whether the Peguero–Lo Presti criteria can improve the accuracy of LVH detection.Methods:This study is a retrospective study,enrolled the patients who have received CMR examination.All patients are divided into two groups according to the left ventricular ejection fraction?LVEF?in the results of CMR.LVEF<50%is for reduced ejection fraction group?n=60?;LVEF?50%is for normal ejection fraction group?n=78?.The left ventricular mass index?LVMI?,which means left ventricular mass?LVM?corrected by body surface area?BSA?,calculated by CMR was used as the diagnostic criteria for LVH,and male?83 g/m² and female?67g/m² for positive.Peguero–Lo Presti criterion—refers to the deepest S wave amplitude?S_D?in all leads plus the S₄ wave amplitude in V4?SV₄?,and male?2.8mV and female?2.3mV for positive.At the same time,the area under the curve?AUC?of the receiver operating characteristic curve?ROC curve?of multiple LVH electrocardiogram diagnostic criteria was calculated to detect the predictive value of LVH.The Delong et al method validated differences in ROC curves for each ECG diagnostic criteria.Mcnemar examined whether there was consistency between the ECG standard and the gold standard.The Kappa test evaluates the degree of agreement between each electrocardiogram standard and the gold standard.The paired chi-square test verifies the difference in sensitivity and specificity between the ECG diagnostic criteria.P value less than 0.05 was considered statistically significant.Results:In the general,there were 94 males,accounting for 68%,and 44females,accounting for 32%,with an average age of 44±16 years.The mean value of LVMI corrected by BSA was 62.21±29.15g/m².A total of 29 patients with confirmed LVH were positive,accounting for 21%of the total.The overall accuracy of the diagnosis of LVH by the Peguero-Lo Presti criteria was not the highest?AUC:0.808,P<0.001?,but withfor the highest sensitivity meet 82.75%.In the general,there was no statistically significant difference in AUC between the Peguero-Lo Presti criteria,the Cornell voltage criteria,the Sokolow-Lyon voltage criteria,and the S_D voltage criteria as verified by the Delong et al method.Mcnemar test showed that there was no consistency between the Peguero-Lo Presti criteria and the gold standard.The Kappa test showed that the Peguero-Lo Presti criteria had poor consistency with the gold standard,the paired chi-square test showed that the Peguero-Lo Presti criteria outperforms the Cornell voltage criteria and the Sokolow-Lyon voltage criteria in sensitivity,and is inferior to the above two in specificity.In the reduced ejection fraction group,the overall accuracy of the diagnosis of LVH by the Peguero-Lo Presti criteria was not the highest?AUC:0.746,P<0.001?,but withfor the highest sensitivity meet 83.3%.In the normal ejection fraction group,the overall accuracy of the diagnosis of LVH by the Peguero-Lo Presti criteria was not the highest?AUC:0.866,P<0.001?,and without the highest sensitivity,for 81.8%.In the groups with reduced ejection fraction and normal ejection fraction,there was no statistically significant difference in AUC between the Peguero-Lo Presti criteria,the Cornell voltage criteria,the Sokolow-Lyon voltage criteria,and the S_D voltage criteria as verified by the Delong et al method.Mcnemar test showed that there was no consistency between the Peguero-Lo Presti criteria and the gold standard.The Kappa test showed that the Peguero-Lo Presti criteria had poor consistency with the gold standard.Paired chi-square test Peguero-Lo Presti criteria sensitivity is not higher than the remaining three,and the specificity is lower than the Cornell voltage criteria.The Peguero-Lo Presti criteria did not show any more test efficacy in each group.The AUC of the Peguero-Lo Presti criteria and S_D voltage criteria in the ejection fraction reduction group was significantly lower than those in the normal ejection fraction group,and the S_D voltage criteria was more significant,suggesting that the overall accuracy of the Peguero-Lo Presti criteria and the S_D voltage criteria were both related to the LVEF.Conclusions:The Peguero-Lo Presti criteria does not improve the overall accuracy of LVH diagnosis in all populations.The overall accuracy of the S_D voltage criteria and the Peguero-Lo Presti criteria for diagnosing LVH is affected by the LVEF value,decreasing the LVEF value can reduce the test efficacy of both,and the S_D voltage criteria is more affected.In people with normal LVEF,the S_D voltage criteria may be better than the Peguero-Lo Presti criteria.