Study in Southern India Among Hypertensive Patients Using ECG To Screen Left Ventricular Hypertrophy - Can We Do It in Rural Health Centres?

BACKGROUND: Electrocardiogram (ECG) is a cost effective tool to evaluate left ventricular hypertrophy (LVH). However, its reliability is often questionable when compared to the gold standard - echocardiography.The validation of ECG as a tool to diagnose LVH would benefit centres that lack access to echocardiography.

AIM: (1) To assess the efficacy of ECG criteria to screen for left ventricular hypertrophy in comparison to echocardiography. (2) To determine whether ECG can be used as a screening tool for LVH in rural primary health centres.

MATERIALS AND METHODS: Fifty hypertensive patients admitted to a tertiary level hospital fulfilling the inclusion and the exclusion criteria, were evaluated for LVH using ECG and echocardiography. Romhilt-Estes and Sokolow-Lyon criteria were applied to all subjects and their efficiency in detecting LVH was measured using Kappa statistics in comparison to echocardiography.

RESULTS: Among the 50 patients, 23 had LVH by echocardiography. In comparison to echocardiography, Romhilt-Estes and Sokolow-Lyon criteria were specific for LVH (96.3%, 88.9% respectively), but were poorly sensitive (43.5%, 43.5%). Combining both the criteria, raised the sensitivity to 60.9% and specificity to 85.2%. Kappa statistical analysis showed moderate to fair agreement of the Romhilt-Estes criteria with echocardiography. Both criteria had high positive predictive values (90.9%, 76.9%).

CONCLUSION: Both Romhilt-Estes and Sokolow-Lyon ECG criteria are poor screening tools due to low sensitivity. But during routine screening of hypertensive patients with ECG alone, if any patient is positive by Romhilt-Estes criteria or both criteria, it would certainly warrant echocardiographic evaluation. As echocardiography cannot be recommended to screen every patient with hypertension in developing countries, initial evaluation using ECG can certainly help in selecting those who require echocardiography.