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New Peguero-Lo Presti criteria for diagnosis of left ventricular hypertrophy – a cardiac magnetic resonance validation study
Session:
CO6 - Imagiologia Cardiovascular
Speaker:
C. M. Espada Guerreiro
Congress:
CPC 2019
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.3 Cardiac Magnetic Resonance
Session Type:
Comunicações Orais
FP Number:
---
Authors:
C. M. Espada Guerreiro; Pedro Oliveira De Azevedo; Ana Raquel Barbosa; Ricardo Ladeiras-Lopes; Nuno Dias Ferreira; Rita Faria; Bruno Melica; João Primo; Paulo Fonseca; Helena Gonçalves; Marco André Oliveira; Pedro Braga
Abstract
<p><strong>Background</strong>: The new Peguero-Lo Presti (PLP) ECG criteria for left ventricular hypertrophy (LVH) showed higher sensitivity and overall accuracy compared with the Cornell (CL) and Sokolow-Lyon (SL) voltage criteria, in hypertensive patients evaluated with echocardiography. The performance of this criteria has not been validated for LVH as defined by cardiac magnetic resonance (CMR), the gold standard method for left ventricular mass (LVM) and volumes evaluation.</p> <p> </p> <p><strong>Objectives</strong>: Evaluate and compare the diagnostic accuracy of PLP, CL and SL voltage criteria for LVH as defined by CMR.</p> <p> </p> <p><strong>Methods</strong>: Retrospective study of 175 patients (>34 years-old) referred for CMR from 01/2015 to 12/2017, who had a concomitant electrocardiogram for review. Patients with complete left or right bundle branch block or ventricular paced rhythm were excluded. CMR was used to estimate the indexed LVM and septal hypertrophy. LVH group patients were defined according to the reference values for gender and age. A control group, adjusted by gender, was randomly selected from a population of 310 consecutive patients referred for CMR and without LVH. We applied the SL, CL voltage and PLP criteria to both groups and evaluated their diagnostic accuracy (AUC analysis). Diagnostic sensitivity and specificity were compared.</p> <p> </p> <p><strong>Results: </strong>175 patients (mean age 64 years; 61% males) were divided into two groups (LVH n=88; control n=87). LVH group had lower prevalence of CAD (23.9% vs 40.2%, p=0.024) and previous CABG (2.3% vs 12.6%, p=0.010). Left atrial volume (91.1±31.2 vs 73.6±23.9 mL, p=0.006) and LVMi (77.9±23.8 vs 54.3±11.2 g/m2, p<0.001) were higher in LVH group. Discrimination by AUC was highest for the PLP criteria (AUC 0.823, p<0.001), followed by CL (AUC 0.808, p<0.001) and SL (AUC 0.690, p<0.001) voltage criteria. The PLP criteria outperformed CL voltage criteria, with higher sensitivity (50% [95% CI: 40-60%] vs. 31% [95% CI: 20-33%], p=0.006) and SL (vs. 28% [95% CI: 20-37%], p=0.003) for LVH diagnosis. The specificities of all the criteria were above 94%, without significant difference between them.</p> <p> </p> <p><strong>Conclusions:</strong></p> <p>In a population with LVH defined by CMR, after adjustment for gender and age, the proposed criteria of PLP showed increased sensitivity for this diagnosis, when compared with the SL and CL voltage criteria. As such, they could become the preferred ECG diagnostic tool when evaluating patients at risk for LVH.</p>
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