Original research article: A comparative study of electrocardiographic and echocardiographic findings for the diagnosis of left ventricular hypertrophy in patients presenting with hypertension
Dr. Jitendra Kumar
Background: Left Ventricular Hypertrophy (LVH) is common in hypertension. The prevalence of LVH increases with the age, severity of hypertension and the duration of hypertension. So presence of LVH indicates a long run of uncontrolled hypertension.
There are many ways of diagnosing LVH like, by electrocardiography (ECG), CXR and echocardiography (ECHO). Though ECHO is superior to ECG, it is economically expensive and not widely available in rural parts of our country. So the purpose of this study is to explore the reliability of ECG in diagnosis of LVH as compared to ECHO in hypertensive patients.
Objectives: The objective of the study was to evaluate the effectiveness of ECG for detection of left ventricular hypertrophy in relation to ECHO in hypertensive patients. Further aim was to analyze the different ECG criteria.
Material and Methods: 100 patients with diagnosis of hypertension after applying inclusion and exclusion criteria, studied over a period of 6 months from 15th May 2017 to 15th November2017 at Narayan Medical College & Hospital, Jamuhar,Sasaram,Distt. Rohtas, Bihar. patients were randomly selected for the study. The data collected from the patients by the detailed clinical history, clinical examination and by ECG using Sokolow Lyon criteria, Romhilt estes point score criteria, Total QRS criteria. 2-D Echocardiography was done in all patients keeping the detection of LVH as endpoint.
Out of 100 hypertensive patients studied 73 patients had LVH by ECHO.
Using Sokolow-Lyon criteria ECG could diagnose LVH in 52 patients with
65 % sensitivity, 70% specificity and Kappa measurement of agreement is 0.33.
Using Romhilt-Estes scoring system ECG could diagnose LVH in 54 patients with 70%, sensitivity, 73% specificity and Kappa measurement of agreement is 0.40.
Using total QRS criteria ECG could diagnose LVH in 53 patients with sensitivity 70%, specificity 76% and Kappa measurement of agreement is 0.43.
Conclusion: In this study we found that the diagnosis of LVH in hypertensive patients, ECG is a sensitive method and can be used as a screening test.
To conclude, ECHO is the method of choice in the detection of LVH in hypertensive patients. All the hypertensive patients should undergo ECHO test to rule out LVH. However, improved ECG criteria like total QRS voltage can be adopted for the detection of LVH because of its fair Kappa measurement of agreement.
Dr. Jitendra Kumar. Original research article: A comparative study of electrocardiographic and echocardiographic findings for the diagnosis of left ventricular hypertrophy in patients presenting with hypertension. International Journal of Medical and Health Research, Volume 3, Issue 11, 2017, Pages 152-154