Evaluation of various electrocardiographic criteria for left ventricular hypertrophy in patients with stable angina pectoris: influence of using modified limb electrodes.
BACKGROUND
Left ventricular hypertrophy (LVH) in coronary heart disease is associated with poor prognosis. Electrocardiography (ECG) criteria for LVH, when using ECG with modified limb electrode positions, has not been validated in patients with angina pectoris.


METHODS
Echocardiography and resting ECGs with modified limb electrode positions, i.e. with the limb leads placed on the abdomen instead of the extremities, were registered from 468 patients (295 men) with stable angina pectoris. To evaluate the influence of using modified limb electrode positions, ECGs with standard and modified limb electrode positions were compared in a control group consisting of 50 other patients.


RESULTS
The ECG criteria for LVH according to the Perugia score, the Minnesota code and Romhilt & Estes reached the highest sensitivity values, 27-31% in men and 24-38% in women, while the sensitivities of different Cornell criteria were as low as 6-10% in men and 19-29% in women. In the control group, the R- and S-wave amplitudes of the precordial leads were only slightly changed, as expected, whereas those of the limb leads changed considerably. Based on these results, we corrected aVL in the main study, which increased the sensitivity of the Cornell voltage criteria from 15 to 30%, while the specificity was maintained at 95%.


CONCLUSIONS
ECGs registered with modified limb electrode positions can be used to detect LVH with traditional ECG criteria, but changes in the limb leads are considerable and influence the sensitivities.
Malmqvist
K
K
Division of Internal Medicine, Karolinska Institutet, Danderyd Hospital, Danderyd, Sweden. karin.malmqvist@med.ds.sll.se
Kahan
T
T
Eriksson
S
S
Björkander
I
I
Held
C
C
Forslund
L
L
Rehnqvist
N
N
Hjemdahl
P
P
D000005:Abdomen; D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000150:complications*; D001132:Arm; D004562:Electrocardiography / Q000295:instrumentation* / Q000379:methods; D004566:Electrodes; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis*; D007866:Leg; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity