Valor del electrocardiograma en el diagnóstico de la hipertrofia ventricular izquierda en la hipertensión arterial
Palabras clave:
hipertensión, hipertrofia ventricular izquierda, electrocardiografía, ecocardiografía, diagnóstico
Resumen
Introducción: la hipertrofia ventricular izquierda es un factor de riesgo independiente de enfermedad cardiovascular. Existen diversos criterios electrocardiográficos para el diagnóstico, con distintas sensibilidades y especificidades.
Objetivo: determinar el valor diagnóstico de los criterios electrocardiográficos de hipertrofia del ventrículo izquierdo en comparación a la ecocardiografía transtorácica en personas adultas con hipertensión arterial.
Material y método: diseño observacional, descriptivo, retrospectivo de corte transversal, tipo prueba diagnóstica, que incluyó a pacientes adultos con diagnóstico de hipertensión arterial internados en las salas de Clínica Médica del Hospital de Clínicas, Paraguay, desde agosto del 2022 a agosto del 2023. Se determinaron las variables demográficas, criterios electrocardiográficos (Sokolov-Lyon, Cornell, Lewis, Peguero Lo Presti) y ecocardiográficos de hipertrofia ventricular izquierda.
Resultados: se evaluaron 517 electrocardiogramas y ecocardiografías de pacientes hipertensos. Según criterio de Sokolov-Lyon la sensibilidad fue 16% y la especificidad 70% para el diagnóstico de la hipertrofia ventricular izquierda; por criterios de Cornell la sensibilidad fue 43% y especificidad 87 %; por criterios de Lewis la sensibilidad fue 26% y especificidad 76% y por criterios de Peguero Lo Presti la sensibilidad fue 63% y la especificidad 87%.
Conclusión: el criterio por electrocardiograma de hipertrofia ventricular izquierda con mayor sensibilidad fue de Peguero Lo Presti y los de mayor especificidad fueron los de Peguero Lo Presti y Cornell.
Citas
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2. You Z, He T, Ding Y, Yang L, Jiang X, Huang L. Predictive value of electrocardiographic left ventricular hypertrophy in the general population: A meta-analysis. J Electrocardiol. 2020;62:14-9. doi: 10.1016/j.jelectrocard.2020.07.001
3. Stanton T, Dunn FG. Hypertension, left ventricular hypertrophy, and myocardial ischemia. Med Clin North Am. 2017;101(1):29-41. doi: 10.1016/j.mcna.2016.08.003
4. Stewart MH, Lavie CJ, Shah S, Englert J, Gilliland Y, Qamruddin S, et al. Prognostic implications of left ventricular hypertrophy. Prog Cardiovasc Dis. 2018; 61(5-6):446-55. doi: 10.1016/j.pcad.2018.11.002
5. Antikainen RL, Peters R, Beckett NS, Fagard RH, Wang JG, Rajkumar Ch, Bulpitt ChJ. Left ventricular hypertrophy is a predictor of cardiovascular events in elderly hypertensive patients: Hypertension in the very elderly trial. J Hypertens. 2016;34(11):2280-6. doi: 10.1097/HJH.0000000000001073
6. Edison ES, Yano Y, Hoshide S, Kario K. Association of electrocardiographic left ventricular hypertrophy with incident cardiovascular disease in Japanese older hypertensive patients. Am J Hypertens. 2015;28(4):527-34. doi: 10.1093/ajh/hpu184
7. Peguero JG, Lo Presti S, Perez J, Issa O, Brenes JC, Tolentino A. Electrocardiographic criteria for the diagnosis of left ventricular hypertrophy. J Am Coll Cardiol [Internet]. 2017 [cited 2023 Mar 10];69(13):1694-1703. Available from: https://pubmed.ncbi.nlm.nih.gov/28359515. doi: 10.1016/j.jacc.2017.01.037
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9. Kothendaraman B, Serane V T, Balasubramanian K. Are Electrocardiographic Criteria reliable for left ventricular hypertrophy detection in Indian adults? Cureus [Internet]. 2023 [cited 2023 Nov 10];15(6):e40306. Available from: https://pubmed.ncbi.nlm.nih.gov/37448432. doi: 10.7759/cureus.40306
10. Wang D, Xu JZ, Zhang W, Chen Y, Li J, An Y, Bian R, Wang JG. Performance of electrocardiographic criteria for echocardiographically diagnosed left ventricular hypertrophy in Chinese hypertensive patients. Am J Hypertens [Internet]. 2020 [cited 2023 Mar 10];33(9):831-6. Available from: https://pubmed.ncbi.nlm.nih.gov/32484222. doi: 10.1093/ajh/hpaa083
11. Peguero JG, Lo Presti S, Perez J, Issa O, Brenes JC, Tolentino A. Reply: Adjustments of electrocardiographic criteria for the diagnosis of left ventricular hypertrophy. J Am Coll Cardiol [Internet]. 2017 [cited 2023 Mar 10];70(5):687. Available from: https://pubmed.ncbi.nlm.nih.gov/28750711. doi: 10.1016/j.jacc.2017.05.059
12. Sun L, Feng H, Ni L, Wang H, Gao D. Realization of fully automated quantification of left ventricular volumes and systolic function using transthoracic 3D echocardiography. Cardiovasc Ultrasound [Internet]. 2018 [cited 2023 May 10]; 16(1):2. Available from: https://pubmed.ncbi.nlm.nih.gov/29357888. doi: 10.1186/s12947-017-0121-8
13. Rolón Acosta PD, Monfredini Saccomani H, Ortiz Galeano I. Valor diagnóstico de los criterios electrocardiográficos de hipertrofia del ventrículo izquierdo en la hipertensión arterial. Rev. virtual Soc. Parag. Med. Int [Internet]. 2019 [citado 24 Nov 2023];6(2):39-46. Disponible en: http://scielo.iics.una.py/scielo.php?script=sci_arttext&pid=S2312-38932019000200039&lng=en. doi: https://doi.org/10.18004/rvspmi/2312-3893/2019.06.02.39-046
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15. Bang CN, Soliman EZ, Simpson LM, Davis BR, Devereux RB, Okin PM. Electrocardiographic left ventricular hypertrophy predicts cardiovascular morbidity and mortality in hypertensive patients: The ALLHAT study. Am J Hypertens [Internet]. 2017 [cited 2023 May 10];30(9):914-22. Available from: https://pubmed.ncbi.nlm.nih.gov/28430947. doi: 10.1093/ajh/hpx067
16. Bonomini MP, Ingallina FJ, Barone V, Antonucci R, Arini PD. Nuevos marcadores electrocardiográficos de hipertrofia ventricular izquierda. Rev Fed Arg Cardiol [Internet]. 2016 [citado 24 Nov 2023]; 45(1): 24-28. Disponible en: https://ri.conicet.gov.ar/bitstream/handle/11336/19017/CONICET_Digital_Nro.22866.pdf?sequence=1&isAllowed=y
17. Isla Alfonso D, Jiménez Puente M, Denis Piedra DA, Rodríguez-Venegas EC, Quevedo Hernández L, Fontaine-Ortiz JE. Valor diagnóstico del índice de Sokolow-Lyon en la hipertrofia ventricular izquierda. CorSalud [Internet]. 2021 [citado 24 Nov 2023];13(2):135-41. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S2078-71702021000200135#:~:text=El%20%C3%ADndice%20de%20Sokolow%2DLyon,confirma%20su%20diagn%C3%B3stico2%2C3
18. Marcato JP, Senra Santos F, Gama Palone A, Lenci Marques G. Evaluation of different criteria in the diagnosis of left ventricular hypertrophy by electrocardiogram in comparison with echocardiogram. Cureus [Internet]. 2022 [cited 2023 Nov 24];14(6): e26376. Available from: https://pubmed.ncbi.nlm.nih.gov/35911263. doi: 10.7759/cureus.26376
19. Noubiap JJ, Agbaedeng TA, Nyaga UF, Nkoke C, Jingi AM. A meta-analytic evaluation of the diagnostic accuracy of the electrocardiographic Peguero-Lo Presti criterion for left ventricular hypertrophy. J Clin Hypertens (Greenwich) [Internet]. 2020 [cited 2023 Nov 24];22(7):1145-53. Available from: https://pubmed.ncbi.nlm.nih.gov/32608577. doi: 10.1111/jch.13923
20. Focaccia Povoa F, Luna Filho B, Bianco HT, Amodeo C, Povoa R, Nogueira Bombig MT, et al. Performance of the electrocardiogram in the diagnosis of left ventricular hypertrophy in older and very older hypertensive patients. Arq Bras Cardiol [Internet]. 2021 [cited 2023 Nov 24];117(5):924-31. Available from: https://pubmed.ncbi.nlm.nih.gov/34378674. doi:10.36660/abc.20200600
21. Yu Z, Song J, Cheng L, Li S, Lu Q, Zhang Y, Lin X, Liu D. Peguero-Lo Presti criteria for the diagnosis of left ventricular hypertrophy: A systematic review and meta-analysis. PLoS One [Internet]. 2021 [cited 2023 Oct 10]; ;16(1): e0246305. Available from: https://pubmed.ncbi.nlm.nih.gov/33513186. doi:
10.1371/journal.pone.0246305
22. Zhang W, Zhou Y, Bai B, Yu S, Xiong J, Chi Ch, et al. Consistency of left ventricular hypertrophy diagnosed by electrocardiography and echocardiography: The Northern Shanghai study. Clin Interv Aging [Internet]. 2019 [cited 2023 Oct 10]; 14:549-56. Available from: https://pubmed.ncbi.nlm.nih.gov/30880935. doi: 10.2147/CIA.S180723
23. Su FY, Li YH, Lin YP, Lee ChJ, Wang ChH, Meng FCh, et al. A comparison of Cornell and Sokolow-Lyon electrocardiographic criteria for left ventricular hypertrophy in a military male population in Taiwan: the Cardiorespiratory fitness and HospItalization Events in armed Forces study. Cardiovasc Diagn Ther [Internet]. 2017 [cited 2023 May 10];7(3):244-51. Available from: https://pubmed.ncbi.nlm.nih.gov/28567350. doi: 10.21037/cdt.2017.01.16
24. Abela M, Sharma S. Electrocardiographic interpretation in athletes. Minerva Cardiol Angiol. 2021;69(5):533-56. doi: 10.23736/S2724-5683.20.05331-1
25. Sengul C, Cakir C, Barutcu S, Sarikaya R. The prevalence and correlates of T-wave inversion in lead III in non-obese men. J Electrocardiol. 2020; 61:66-70. doi: 10.1016/j.jelectrocard.2020.05.008
26. Germano G. Electrocardiographic signs of left ventricular hypertrophy in obese patients: what criteria should be used? High Blood Press Cardiovasc Prev [Internet]. 2015 [cited 2023 Oct 10];22(1):5-9. Available from: https://link.springer.com/article/10.1007/s40292-014-0062-3. doi: 10.1007/s40292-014-0062-3
27. Kunisek J, Zaputovic L, Cubranic Z, Kunisek L, Zuvic Butorac M, Lukin-Eskinja K, Karlavaris R. Influence of the left ventricular types on QT intervals in hypertensive patients. Anatol J Cardiol [Internet]. 2015 [cited 2023 Oct 10];15(1):33-9. Available from: https://pubmed.ncbi.nlm.nih.gov/25179883/ doi: 10.5152/akd.2014.5134
2. You Z, He T, Ding Y, Yang L, Jiang X, Huang L. Predictive value of electrocardiographic left ventricular hypertrophy in the general population: A meta-analysis. J Electrocardiol. 2020;62:14-9. doi: 10.1016/j.jelectrocard.2020.07.001
3. Stanton T, Dunn FG. Hypertension, left ventricular hypertrophy, and myocardial ischemia. Med Clin North Am. 2017;101(1):29-41. doi: 10.1016/j.mcna.2016.08.003
4. Stewart MH, Lavie CJ, Shah S, Englert J, Gilliland Y, Qamruddin S, et al. Prognostic implications of left ventricular hypertrophy. Prog Cardiovasc Dis. 2018; 61(5-6):446-55. doi: 10.1016/j.pcad.2018.11.002
5. Antikainen RL, Peters R, Beckett NS, Fagard RH, Wang JG, Rajkumar Ch, Bulpitt ChJ. Left ventricular hypertrophy is a predictor of cardiovascular events in elderly hypertensive patients: Hypertension in the very elderly trial. J Hypertens. 2016;34(11):2280-6. doi: 10.1097/HJH.0000000000001073
6. Edison ES, Yano Y, Hoshide S, Kario K. Association of electrocardiographic left ventricular hypertrophy with incident cardiovascular disease in Japanese older hypertensive patients. Am J Hypertens. 2015;28(4):527-34. doi: 10.1093/ajh/hpu184
7. Peguero JG, Lo Presti S, Perez J, Issa O, Brenes JC, Tolentino A. Electrocardiographic criteria for the diagnosis of left ventricular hypertrophy. J Am Coll Cardiol [Internet]. 2017 [cited 2023 Mar 10];69(13):1694-1703. Available from: https://pubmed.ncbi.nlm.nih.gov/28359515. doi: 10.1016/j.jacc.2017.01.037
8. De la Garza Salazar F, Rodríguez Díaz EA, González Cantú A, Azpiri López JR, Kuri Ayache M, Romero Ibarguengoitia ME. Diagnostic utility of the electrocardiographic left ventricular hypertrophy criteria in specific populations. Acta Cardiol. 2021;76(3):272-9. doi: 10.1080/00015385.2020.1721718
9. Kothendaraman B, Serane V T, Balasubramanian K. Are Electrocardiographic Criteria reliable for left ventricular hypertrophy detection in Indian adults? Cureus [Internet]. 2023 [cited 2023 Nov 10];15(6):e40306. Available from: https://pubmed.ncbi.nlm.nih.gov/37448432. doi: 10.7759/cureus.40306
10. Wang D, Xu JZ, Zhang W, Chen Y, Li J, An Y, Bian R, Wang JG. Performance of electrocardiographic criteria for echocardiographically diagnosed left ventricular hypertrophy in Chinese hypertensive patients. Am J Hypertens [Internet]. 2020 [cited 2023 Mar 10];33(9):831-6. Available from: https://pubmed.ncbi.nlm.nih.gov/32484222. doi: 10.1093/ajh/hpaa083
11. Peguero JG, Lo Presti S, Perez J, Issa O, Brenes JC, Tolentino A. Reply: Adjustments of electrocardiographic criteria for the diagnosis of left ventricular hypertrophy. J Am Coll Cardiol [Internet]. 2017 [cited 2023 Mar 10];70(5):687. Available from: https://pubmed.ncbi.nlm.nih.gov/28750711. doi: 10.1016/j.jacc.2017.05.059
12. Sun L, Feng H, Ni L, Wang H, Gao D. Realization of fully automated quantification of left ventricular volumes and systolic function using transthoracic 3D echocardiography. Cardiovasc Ultrasound [Internet]. 2018 [cited 2023 May 10]; 16(1):2. Available from: https://pubmed.ncbi.nlm.nih.gov/29357888. doi: 10.1186/s12947-017-0121-8
13. Rolón Acosta PD, Monfredini Saccomani H, Ortiz Galeano I. Valor diagnóstico de los criterios electrocardiográficos de hipertrofia del ventrículo izquierdo en la hipertensión arterial. Rev. virtual Soc. Parag. Med. Int [Internet]. 2019 [citado 24 Nov 2023];6(2):39-46. Disponible en: http://scielo.iics.una.py/scielo.php?script=sci_arttext&pid=S2312-38932019000200039&lng=en. doi: https://doi.org/10.18004/rvspmi/2312-3893/2019.06.02.39-046
14. Yildiz M, Oktay AA, Stewart MH, Milani RV, Ventura HO, Lavie CJ. Left ventricular hypertrophy and hypertension. Prog Cardiovasc Dis. 2020;63(1):10-21. doi: 10.1016/j.pcad.2019.11.009
15. Bang CN, Soliman EZ, Simpson LM, Davis BR, Devereux RB, Okin PM. Electrocardiographic left ventricular hypertrophy predicts cardiovascular morbidity and mortality in hypertensive patients: The ALLHAT study. Am J Hypertens [Internet]. 2017 [cited 2023 May 10];30(9):914-22. Available from: https://pubmed.ncbi.nlm.nih.gov/28430947. doi: 10.1093/ajh/hpx067
16. Bonomini MP, Ingallina FJ, Barone V, Antonucci R, Arini PD. Nuevos marcadores electrocardiográficos de hipertrofia ventricular izquierda. Rev Fed Arg Cardiol [Internet]. 2016 [citado 24 Nov 2023]; 45(1): 24-28. Disponible en: https://ri.conicet.gov.ar/bitstream/handle/11336/19017/CONICET_Digital_Nro.22866.pdf?sequence=1&isAllowed=y
17. Isla Alfonso D, Jiménez Puente M, Denis Piedra DA, Rodríguez-Venegas EC, Quevedo Hernández L, Fontaine-Ortiz JE. Valor diagnóstico del índice de Sokolow-Lyon en la hipertrofia ventricular izquierda. CorSalud [Internet]. 2021 [citado 24 Nov 2023];13(2):135-41. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S2078-71702021000200135#:~:text=El%20%C3%ADndice%20de%20Sokolow%2DLyon,confirma%20su%20diagn%C3%B3stico2%2C3
18. Marcato JP, Senra Santos F, Gama Palone A, Lenci Marques G. Evaluation of different criteria in the diagnosis of left ventricular hypertrophy by electrocardiogram in comparison with echocardiogram. Cureus [Internet]. 2022 [cited 2023 Nov 24];14(6): e26376. Available from: https://pubmed.ncbi.nlm.nih.gov/35911263. doi: 10.7759/cureus.26376
19. Noubiap JJ, Agbaedeng TA, Nyaga UF, Nkoke C, Jingi AM. A meta-analytic evaluation of the diagnostic accuracy of the electrocardiographic Peguero-Lo Presti criterion for left ventricular hypertrophy. J Clin Hypertens (Greenwich) [Internet]. 2020 [cited 2023 Nov 24];22(7):1145-53. Available from: https://pubmed.ncbi.nlm.nih.gov/32608577. doi: 10.1111/jch.13923
20. Focaccia Povoa F, Luna Filho B, Bianco HT, Amodeo C, Povoa R, Nogueira Bombig MT, et al. Performance of the electrocardiogram in the diagnosis of left ventricular hypertrophy in older and very older hypertensive patients. Arq Bras Cardiol [Internet]. 2021 [cited 2023 Nov 24];117(5):924-31. Available from: https://pubmed.ncbi.nlm.nih.gov/34378674. doi:10.36660/abc.20200600
21. Yu Z, Song J, Cheng L, Li S, Lu Q, Zhang Y, Lin X, Liu D. Peguero-Lo Presti criteria for the diagnosis of left ventricular hypertrophy: A systematic review and meta-analysis. PLoS One [Internet]. 2021 [cited 2023 Oct 10]; ;16(1): e0246305. Available from: https://pubmed.ncbi.nlm.nih.gov/33513186. doi:
10.1371/journal.pone.0246305
22. Zhang W, Zhou Y, Bai B, Yu S, Xiong J, Chi Ch, et al. Consistency of left ventricular hypertrophy diagnosed by electrocardiography and echocardiography: The Northern Shanghai study. Clin Interv Aging [Internet]. 2019 [cited 2023 Oct 10]; 14:549-56. Available from: https://pubmed.ncbi.nlm.nih.gov/30880935. doi: 10.2147/CIA.S180723
23. Su FY, Li YH, Lin YP, Lee ChJ, Wang ChH, Meng FCh, et al. A comparison of Cornell and Sokolow-Lyon electrocardiographic criteria for left ventricular hypertrophy in a military male population in Taiwan: the Cardiorespiratory fitness and HospItalization Events in armed Forces study. Cardiovasc Diagn Ther [Internet]. 2017 [cited 2023 May 10];7(3):244-51. Available from: https://pubmed.ncbi.nlm.nih.gov/28567350. doi: 10.21037/cdt.2017.01.16
24. Abela M, Sharma S. Electrocardiographic interpretation in athletes. Minerva Cardiol Angiol. 2021;69(5):533-56. doi: 10.23736/S2724-5683.20.05331-1
25. Sengul C, Cakir C, Barutcu S, Sarikaya R. The prevalence and correlates of T-wave inversion in lead III in non-obese men. J Electrocardiol. 2020; 61:66-70. doi: 10.1016/j.jelectrocard.2020.05.008
26. Germano G. Electrocardiographic signs of left ventricular hypertrophy in obese patients: what criteria should be used? High Blood Press Cardiovasc Prev [Internet]. 2015 [cited 2023 Oct 10];22(1):5-9. Available from: https://link.springer.com/article/10.1007/s40292-014-0062-3. doi: 10.1007/s40292-014-0062-3
27. Kunisek J, Zaputovic L, Cubranic Z, Kunisek L, Zuvic Butorac M, Lukin-Eskinja K, Karlavaris R. Influence of the left ventricular types on QT intervals in hypertensive patients. Anatol J Cardiol [Internet]. 2015 [cited 2023 Oct 10];15(1):33-9. Available from: https://pubmed.ncbi.nlm.nih.gov/25179883/ doi: 10.5152/akd.2014.5134
