PURPOSE: The accuracy of electrocardiogram (EKG) in diagnosing left ventricular hypertrophy (LVH) in the very elderly population is unknown. We intended to evaluate the sensitivity and specificity of EKG in diagnosing LVH in a nonagenarian population and the factors affecting them with echocardiogram as the gold standard.
METHODS: We retrospectively evaluated the clinical history, electrocardiograms of 388 consecutive nonagenarians who underwent transthoracic echocardiogram in our center between October 2003 and November 2006. Patients with left bundle branch block, ventricular paced rhythm, moderate to severe pericardial effusion, infiltrative cardiac diseases were excluded. Gender-specific, left ventricular posterior and septal wall measurements were used to diagnose LVH by echocardiogram as per the current guidelines. Sokolov-Lyon Index and the Cornell voltage criteria were used to diagnose LVH by EKG.
RESULTS: The mean age of the 388 patients in the study was 92.3 years with 102 (26%) males and 286 (74%) females. LVH was identified in 301 (78%) patients by echocardiogram of which 182 (47%), 90 (23%) and 29 (8%) had mild, moderate and severe LVH respectively. Only 80 (21%) patients were diagnosed with LVH using the EKG criteria. The overall sensitivity and specificity of EKG to diagnose LVH was 22.9% and 87.4% respectively. The accuracy was similar among males and females. The sensitivity and specificity in patients >95 years was lower than those < 95 years (18.6% and 64% vs 23.9% and 92.8% respectively). As the body mass index (BMI) increased the sensitivity decreased and the specificity increased. The sensitivity in patients with BMI < 20, 20-24.9, 25-29.9 and >30 were 32.3%, 26%, 20% and 24.4% respectively. The specificity in the above BMI groups were 75%, 86.7%, 88% and 100% respectively.
CONCLUSION: EKG is very insensitive in diagnosing LVH in nonagenarians. The accuracy is lesser in patients >95 years of age than those < 95 years. With increasing BMI, the sensitivity decreases and specificity increases.
CLINICAL IMPLICATIONS: EKG is not a reliable tool in diagnosing LVH in the very elderly, particularly in the higher BMI groups.
DISCLOSURE: Yeruva Reddy, No Financial Disclosure Information; No Product/Research Disclosure Information