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Submitted: 18 January 2017 Modified: 19 January 2017
HERDIN Record #: NCR-PHC-17011810205849

Modified chest lead placement to detect left ventricular hypertrophy.

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Background and aim of the study: The standard electrocardiography is a specific, but poorly sensitive tool for diagnosis of left ventricular hypertrophy. Several methods have been designed to increase sensitivity and specificity of ECG. The aim of this study is to test the prognostic value of modified electrocardiographic method, modified chest lead placement, for the diagnosis of left ventricular hypertrophy among hypertensive patients and compare it with the standard method.


Methods: This is a validity study. Study population included all patients diagnosed with hypertension seen at the Hypertension Clinic, Emergency Room and the ward at the Philippine Heart Center from April 2007 to November 2008. Two 12 lead ECG tracings will be obtained, one using the standard method and the other, using the modified method. These data will be encoded into the computer for statistical analysis. 


Results: The age of the patients was 57.4 ± 4.7 years. With the 198 patients studied, the sensitivity, specificity, positive predictive value, and negative predictive value of the tests used were calculated, comparing the standard method with the modified method. The sensitivity and specificity of the standard method using the criterion, RV5 ≥26mm, were 2l.3% and 96.5%, respectively with positive predictive value of 93.8%, and negative predictive value of 33.1%. The sensitivity and specificity of the standard method using the criterion, SVI + RV5 ≥26mm, were 33.3% and 96.5%, respectively with positive predictive value of 95.9%, and negative predictive value of 36.9%. The sensitivity and specificity values of the standard method using the criterion, R in AVL ≥ 11mm were 7.8% and 100%, with positive predictive value of 100%, and negative predictive value of 30%. The sensitivity and specificity of the modified method using the criterion, RV5 ≥ 26mm were 35.5% and 93%, with positive predictive value of 92.6%, and negative predictive value of 36.8 %. The sensitivity and specificity of the modified method sing the criterion, SV1 + RV5 ≥26mm were 40.4% and 87.7%, with positive predictive value of 89.1%, and negative predictive value of 37.3%. The sensitivity and specificity values of the modified method using the criterion, R in AVL ≥11mm were 7.8% and 100%, with positive predictive value of 100%, and negative predictive value of 30%.


 Conclusion: The power of some of the more commonly used electrocardiographic criteria to rule out the diagnosis of left ventricular hypertrophy in patients with hypertension is low. The modified chest lead placement used in this study was able to increase the sensitivity, with good specificity, when using the Sokolow-Lyon criteria in detecting left ventricular hypertrophy. The sensitivity increased by as much as 21% with almost 90% specificity.


 

Publication Type
Research Project
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Philippine Heart Center Medical Library PHC.R.070.06 Fulltext Print Format