Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review

doi:10.1136/bmj.39276.636354.AE

BMJ, doi: 10.1136/bmj.39276.636354.AE, (Published 28 August 2007)

Research

Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review

Daniel Pewsner, senior research fellow in general practice; and general practitioner¹, Peter Jüni, reader in clinical epidemiology², Matthias Egger, professor³, Markus Battaglia, senior research fellow in general practice; and general practitioner¹, Johan Sundström, associate professor⁴, Lucas M Bachmann, reader in clinical epidemiology and deputy director⁵

¹ Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, CH-3012 Berne, Switzerland; and Medix General Practice Network, Bern, Switzerland, ² Institute of Social and Preventive Medicine (ISPM), University of Bern, ³ Institute of Social and Preventive Medicine (ISPM), University of Bern; and Department of Social Medicine, University of Bristol, Bristol, ⁴ Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden, ⁵ Horten Centre, University of Zurich, Zurich, Switzerland

Correspondence to: M Egger egger{at}ispm.unibe.ch

Objective To review the accuracy of electrocardiography in screeningfor left ventricular hypertrophy in patients with hypertension.

Design Systematic review of studies of test accuracy of sixelectrocardiographic indexes: the Sokolow-Lyon index, Cornellvoltage index, Cornell product index, Gubner index, and Romhilt-Estesscores with thresholds for a positive test of $≥$ 4 points or $≥$ 5points.

Data sources Electronic databases ((Pre-)Medline, Embase), referencelists of relevant studies and previous reviews, and experts.

Study selection Two reviewers scrutinised abstracts and examinedpotentially eligible studies. Studies comparing the electrocardiographicindex with echocardiography in hypertensive patients and reportingsufficient data were included.

Data extraction Data on study populations, echocardiographiccriteria, and methodological quality of studies were extracted.

Data synthesis Negative likelihood ratios, which indicate towhat extent the posterior odds of left ventricular hypertrophyis reduced by a negative test, were calculated.

Results 21 studies and data on 5608 patients were analysed.The median prevalence of left ventricular hypertrophy was 33%(interquartile range 23-41%) in primary care settings (10 studies)and 65% (37-81%) in secondary care settings (11 studies). Themedian negative likelihood ratio was similar across electrocardiographicindexes, ranging from 0.85 (range 0.34-1.03) for the Romhilt-Estesscore (with threshold $≥$ 4 points) to 0.91 (0.70-1.01) for theGubner index. Using the Romhilt-Estes score in primary care,a negative electrocardiogram result would reduce the typicalpre-test probability from 33% to 31%. In secondary care thetypical pre-test probability of 65% would be reduced to 63%.

Conclusion Electrocardiographic criteria should not be usedto rule out left ventricular hypertrophy in patients with hypertension.

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