Diagnostic Utility of Electrocardiography and Transthoracic Echocardiography in the Diagnosis of Left Ventricular Hypertrophy in Patients With Known Hypertension

Left ventricular hypertrophy (LVH) is a significant risk factor for cardiovascular events. The increase in LV mass is usually screened by electrocardiography (ECG), which is often insensitive. Despite being insensitive, ECG is cost-effective compared with echocardiography. Therefore, this study aimed to assess the diagnostic utility of ECG and echocardiography in the diagnosis of LVH among patients with hypertension.
 
This comparative prospective study was carried out on 200 patients with hypertension. ECG and echocardiography were performed on all the patients to evaluate the presence of LVH. The Sokolow–Lyon index, the Romhilt–Estes point, and the Cornell voltage criteria were the ECG criteria used. For 2D echocardiography, interventricular septal thickness (IVST) and left ventricular posterior wall thickness (LVPWT) were considered. The χ2 test was employed to test the significance of the qualitative variables. A P value of less than 0.05 was considered statistically significant.
 
The specificity of the Cornell voltage criteria was high compared with that of the other criteria of ECG, although the sensitivity was low for all the other ECG criteria. The occurrence of LVH according to the IVST criteria of 2D echocardiography was significantly associated with the severity and duration of hypertension (P = 0.042). The majority of the patients with diastolic dysfunction were in Stage I hypertension.
 
The diagnostic utility of ECG compared with echocardiography was found to be insensitive. Hence, echocardiography is the preferred method in the detection of LVH in patients with hypertension. However, improved ECG criteria can be adopted in the future for LVH detection due to its cost-effective nature. (Iranian Heart Journal 2021; 22(1): 74-83)