Cardiovascular Disease |

Same-Day Variability of ECG Voltage Criteria for the Diagnosis of Left Ventricular Hypertrophy: Implications for Clinical Practice FREE TO VIEW

Alexander Crystal, MD; Sandeep Ravi, MD; Stuart Zarich, MD; Gilead Lancaster, MD; Craig McPherson, MD
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Bridgeport Hospital, Yale University, Bridgeport, CT

Chest. 2013;144(4_MeetingAbstracts):167A. doi:10.1378/chest.1678832
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SESSION TITLE: Cardiovascular Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Although same-day variability of computer-assisted electrocardiogram (ECG) interpretation is clinically reported, information regarding its effects on the ECG diagnosis of left ventricular hypertrophy (LVH) is limited; this is the focus of our study.

METHODS: Among our hospital database of 12-lead ECGs obtained in 34,285 patients, we identified 3,860 patients in whom 2 ECGs were recorded on the same calendar day (ECGs with acute myocardial infarction, WPW pattern, ventricular pacing, bundle branch block and pericardial tamponade were excluded). Using computer-derived voltage in each lead, we analyzed the same-day variability of 5 standard LVH voltage criteria (all endorsed by 2009 multi-society ECG guidelines): R-aVL>11mV; R-lead I>15mV; RV1+RV5 or 6>35mV; SV3+RaVL>28mV (men) or >20mV (women); and R-lead I+S-lead III>25mV.

RESULTS: The prevalence of ECG-diagnosed LVH ranged from 5% to 13% among the 5 ECG voltage criteria. Among patients who met at least one voltage criterion for LVH on at least one ECG, between 47% and 61% (average = 52%) did not meet the same criterion on a second ECG recorded on the same day.

CONCLUSIONS: The prevalence of ECG-determined LVH in a general hospital-based population is low (<15%). Same day variability of computer-derived ECG voltage is high. By each of 5 standard ECG voltage criteria for LVH, approximately half of patients labeled as having LVH voltage were reclassified as not having it on the same day.

CLINICAL IMPLICATIONS: Low prevalence and high same day variability of ECG voltage criteria for LVH compromises the ability of the ECG to correctly identify LVH on any given tracing. Thus, diagnosing the presence of LVH, or its progression or regression on serial tracings, based on ECG voltage may be poor practice. Whether people who have LVH voltage on more than one ECG tracing on the same day are more accurately diagnosed requires further study using morphometric determination of LVH to serve as a gold standard.

DISCLOSURE: The following authors have nothing to disclose: Alexander Crystal, Sandeep Ravi, Stuart Zarich, Gilead Lancaster, Craig McPherson

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