Usefulness of ECG criteria to rule out left ventricular hypertrophy in older individuals with true left bundle branch block: an observational study

Abstract Background Advanced age is associated with both left bundle branch block (LBBB) and hypertension and the usefulness of ECG criteria to detect left ventricular hypertrophy (LVH) in patients with LBBB is still unclear. The diagnostic performance and clinical applicability of ECG-based LVH cri...

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Autores principales:	Caio Assis Moura Tavares, Nelson Samesima, Felippe Lazar Neto, Ludhmila Abrahão Hajjar, Lucas C. Godoy, Eduardo Messias Hirano Padrão, Mirella Facin, Wilson Jacob Filho, Michael E. Farkouh, Carlos Alberto Pastore
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Hypertension Electrocardiography Left bundle branch block Elderly Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/cd4d4432403a46c8b849871df6fd1eb8
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spelling	oai:doaj.org-article:cd4d4432403a46c8b849871df6fd1eb82021-11-21T12:04:07ZUsefulness of ECG criteria to rule out left ventricular hypertrophy in older individuals with true left bundle branch block: an observational study10.1186/s12872-021-02332-81471-2261https://doaj.org/article/cd4d4432403a46c8b849871df6fd1eb82021-11-01T00:00:00Zhttps://doi.org/10.1186/s12872-021-02332-8https://doaj.org/toc/1471-2261Abstract Background Advanced age is associated with both left bundle branch block (LBBB) and hypertension and the usefulness of ECG criteria to detect left ventricular hypertrophy (LVH) in patients with LBBB is still unclear. The diagnostic performance and clinical applicability of ECG-based LVH criteria in patients with LBBB defined by stricter ECG criteria is unknown. The aim of this study was to compare diagnostic accuracy and clinical utility of ECG criteria in patients with advanced age and strict LBBB criteria. Methods Retrospective single-center study conducted from Jan/2017 to Mar/2018. Patients undergoing both ECG and echocardiogram examinations were included. Ten criteria for ECG-based LVH were compared using LVH defined by the echocardiogram as the gold standard. Sensitivity, specificity, predictive values, likelihood ratios, AUC, and the Brier score were used to compare diagnostic performance and a decision curve analysis was performed. Results From 4621 screened patients, 68 were included, median age was 78.4 years, (IQR 73.3–83.4), 73.5% with hypertension. All ECG criteria failed to provide accurate discrimination of LVH with AUC range between 0.54 and 0.67, and no ECG criteria had a balanced tradeoff between sensitivity and specificity. No ECG criteria consistently improved the net benefit compared to the strategy of performing routine echocardiogram in all patients in the decision curve analysis within the 10–60% probability threshold range. Conclusion ECG-based criteria for LVH in patients with advanced age and true LBBB lack diagnostic accuracy or clinical usefulness and should not be routinely assessed.Caio Assis Moura TavaresNelson SamesimaFelippe Lazar NetoLudhmila Abrahão HajjarLucas C. GodoyEduardo Messias Hirano PadrãoMirella FacinWilson Jacob FilhoMichael E. FarkouhCarlos Alberto PastoreBMCarticleHypertensionElectrocardiographyLeft bundle branch blockElderlyDiseases of the circulatory (Cardiovascular) systemRC666-701ENBMC Cardiovascular Disorders, Vol 21, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Hypertension Electrocardiography Left bundle branch block Elderly Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Hypertension Electrocardiography Left bundle branch block Elderly Diseases of the circulatory (Cardiovascular) system RC666-701 Caio Assis Moura Tavares Nelson Samesima Felippe Lazar Neto Ludhmila Abrahão Hajjar Lucas C. Godoy Eduardo Messias Hirano Padrão Mirella Facin Wilson Jacob Filho Michael E. Farkouh Carlos Alberto Pastore Usefulness of ECG criteria to rule out left ventricular hypertrophy in older individuals with true left bundle branch block: an observational study
description	Abstract Background Advanced age is associated with both left bundle branch block (LBBB) and hypertension and the usefulness of ECG criteria to detect left ventricular hypertrophy (LVH) in patients with LBBB is still unclear. The diagnostic performance and clinical applicability of ECG-based LVH criteria in patients with LBBB defined by stricter ECG criteria is unknown. The aim of this study was to compare diagnostic accuracy and clinical utility of ECG criteria in patients with advanced age and strict LBBB criteria. Methods Retrospective single-center study conducted from Jan/2017 to Mar/2018. Patients undergoing both ECG and echocardiogram examinations were included. Ten criteria for ECG-based LVH were compared using LVH defined by the echocardiogram as the gold standard. Sensitivity, specificity, predictive values, likelihood ratios, AUC, and the Brier score were used to compare diagnostic performance and a decision curve analysis was performed. Results From 4621 screened patients, 68 were included, median age was 78.4 years, (IQR 73.3–83.4), 73.5% with hypertension. All ECG criteria failed to provide accurate discrimination of LVH with AUC range between 0.54 and 0.67, and no ECG criteria had a balanced tradeoff between sensitivity and specificity. No ECG criteria consistently improved the net benefit compared to the strategy of performing routine echocardiogram in all patients in the decision curve analysis within the 10–60% probability threshold range. Conclusion ECG-based criteria for LVH in patients with advanced age and true LBBB lack diagnostic accuracy or clinical usefulness and should not be routinely assessed.
format	article
author	Caio Assis Moura Tavares Nelson Samesima Felippe Lazar Neto Ludhmila Abrahão Hajjar Lucas C. Godoy Eduardo Messias Hirano Padrão Mirella Facin Wilson Jacob Filho Michael E. Farkouh Carlos Alberto Pastore
author_facet	Caio Assis Moura Tavares Nelson Samesima Felippe Lazar Neto Ludhmila Abrahão Hajjar Lucas C. Godoy Eduardo Messias Hirano Padrão Mirella Facin Wilson Jacob Filho Michael E. Farkouh Carlos Alberto Pastore
author_sort	Caio Assis Moura Tavares
title	Usefulness of ECG criteria to rule out left ventricular hypertrophy in older individuals with true left bundle branch block: an observational study
title_short	Usefulness of ECG criteria to rule out left ventricular hypertrophy in older individuals with true left bundle branch block: an observational study
title_full	Usefulness of ECG criteria to rule out left ventricular hypertrophy in older individuals with true left bundle branch block: an observational study
title_fullStr	Usefulness of ECG criteria to rule out left ventricular hypertrophy in older individuals with true left bundle branch block: an observational study
title_full_unstemmed	Usefulness of ECG criteria to rule out left ventricular hypertrophy in older individuals with true left bundle branch block: an observational study
title_sort	usefulness of ecg criteria to rule out left ventricular hypertrophy in older individuals with true left bundle branch block: an observational study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/cd4d4432403a46c8b849871df6fd1eb8
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Usefulness of ECG criteria to rule out left ventricular hypertrophy in older individuals with true left bundle branch block: an observational study

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