TITLE:
Refinement of total 12-lead QRS voltage criteria for diagnosing left ventricular hypertrophy
AUTHORS:
Deepti Kumar, Rishi Bajaj, Lovely Chhabra, David H. Spodick
KEYWORDS:
ECG; QRS Voltage; Left Ventricular Hypertrophy; Echocardiography; Interventricular Septum
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.3 No.2,
April
25,
2013
ABSTRACT: Objective: We sought to test
the hypothesis that the total QRS voltage without either set of the limb leads
(I, II, III) or (R, L, F) may be a better indicator of LVH as compared to the
total QRS voltage. Background: The total 12 lead QRS voltage has been a
validated electrocardiographic criterion for left ventricular hypertrophy
(LVH), with an upper limit of175
mm. However, there is some redundancy in this measurement as
the output of the limb leads is repeated because leads I, II, III, and R, L,
F use the same three electrodes. Methods: 43 unselected, consecutive
echocardiograms were examined for evidence of LVH by wall thickness. Electrocardiogram
(ECG) of these patients within a week of the echocardiogram were then
examined for the total 12 leads QRS voltage, minus I, II, III and total minus
R, L, F voltages. ECG findings were then compared with corresponding
echocardiographic dimensions. Results: A total QRS voltage of123 mmon ECG yielded a sensitivity of
73% and specificity of 67% for diagnosing
LVH with 95% CI = 0.59 - 0.89, p = 0.007. Total minus (R, L and F) value
of110 mmon ECG appears
to give the best sensitivity (73%), specificity (72%), and accuracy (64%
negative predictive value and 82% positive predictive value) for LVH. Conclusion:
It appears that total QRS voltage minus either set of the limb leads,
especially the total minus R, L and F is a better criterion, with110 mmbeing the best specific, sensitive
and accurate index for diagnosing LVH.