Validity of electrocardiogram for detecting left ventricular hypertrophy in younger South African patients

Robertson, Gordon

Validity of electrocardiogram for detecting left ventricular hypertrophy in younger South African patients

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Medicine

Faculty

Faculty of Health Sciences

Abstract

Aim The aim of this study is to compare ECG criteria for LVH on ECG to transthoracic echocardiographic (TTE) defined-LVH in patients with hypertension between the ages of 18 and 45 years. Methods This study was a retrospective cross-sectional analysis of patients (ages 18 to 45 years old) with hypertension attending the Hypertension Clinic in a tertiary medical center in Cape Town, South Africa. Patients who had electrocardiograms (ECG) and transthoracic echocardiograms (TTE) data were collected. TTE was used as the gold standard for left ventricular hypertrophy (LVH) and various common ECG criteria for LVH were compared: Sokolow-Lyon, Obesity-adjusted Sokolow Lyon, Cornel Index, Cornell Product, R in aVL >11mm and R in V4-V6 >25mm. The data were analysed in two subgroups: younger (age 18 to 30 years) and older (31 to 45 years). Results This study included 71 participants with a median age of 30.8 years (54% male), the younger subgroup had 33 participants and the older sub-group had 38 participants. LVH was present on TTE in 51% of participants. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for any ECG criteria being positive in a patient aged 18 to 45 years with TTEdefined LVH was 67%, 46%, 56% and 57% respectively. The following ECG criteria had very good specificity: R in aVL (97%), Cornell index (97%), Cornell Product (89%), R in V4-V6 (86%) and Sokolow-Lyon (77%). The sensitivities were poor with Cornell product (25%), R in aVL >11mm (14%) and R in V4-V6 >25mm (19%). The criteria with better sensitivities were Sokolow-Lyon (50%) and Obesity-adjusted Sokolow-Lyon (58%). The criterion R in V4-V6 >25mm had an exceptionally poor PPV of 17% in the younger age group. Conclusion The commonly used ECG criteria have poor sensitivities and therefore are not useful for screening for LVH. The obesity adjusted Sokolow-Lyon criteria did improve sensitivity slightly (50 to 58%) with a significant reduction in specificity (77% to 54%). The R in V4-V6 >25mm criterion performed poorly in the younger age group due to a large number of false positives and cannot be used for assessing presence of LVH in younger patients. This study showed that patients aged 18 to 45 years with a positive Cornell Index, Cornell product or R in aVL>11mm was very specific for LVH. In a resource constrained setting this could save cost by reducing the number of TTEs required to assess for hypertension mediated target organ damage (HMOD) in patients who do not have another indication for TTE.

Keywords

Internal Medicine

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