Validity of electrocardiographic classification of left ventricular hypertrophy across adult ethnic groups with echocardiography as a standard.
OBJECTIVE
To assess the validity of the electrocardiogram (ECG) as a diagnostic tool for left ventricular hypertrophy (LVH) for different ethnic groups with echocardiography as a standard.


METHODS
Systematic review of the literature using the Cornell and Sokolow-Lyon voltage criteria for LVH.


RESULTS
Five studies were identified. Pooled data from these studies demonstrated low sensitivity using both types of ECG criteria for white and African-origin groups, but with slightly higher sensitivity values for the African-origin group (Cornell, 31.2%; 95% confidence interval [CI], 28%-34.8%; Sokolow-Lyon, 32.9%; 95% CI, 29.5%-36.4%) compared with the white group (Cornell, 26.5%; 95% CI, 25.2%-27.8%; Sokolow-Lyon, 18.2%; 95% CI, 17.2%-19.3%). Specificity was high using both types of criteria in the white group (Cornell, 87.4%; 95% CI, 86.4%-88.4%; Sokolow-Lyon, 88.9%; 95% CI, 88%-90%) but was much lower in the African-origin group using the Sokolow-Lyon criteria (72.1%; 95% CI, 68.7%-75.3%). Specificity was high however for the African-origin group using the Cornell criteria (86.2%, 95% CI, 83.4%-88.5%).


CONCLUSIONS
Both types of criteria are more sensitive in African-origin populations. The Sokolow-Lyon criteria are less specific for LVH in people of African origin. The evidence favors the Cornell criteria in research and service contexts involving African-origin and white populations. Further research is needed to adapt ECG criteria to take into account ethnicity to a greater degree. The issue needs to be studied in a broader range of ethnic groups.
Vanezis
Andrew Peter
AP
Foundation Doctor, Colchester University Hospital, UK. andrewvanezis@doctors.org.uk
Bhopal
Raj
R
D044383:Black People / Q000706:statistics & numerical data*; D004452:Echocardiography / Q000706:statistics & numerical data*; D004562:Electrocardiography / Q000706:statistics & numerical data*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000208:ethnology*; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity