title: Accuracy of chest radiography plus electrocardiogram in diagnosis of hypertrophy in hypertension.
abstract: BACKGROUND
  Chest radiography and electrocardiogram have been criticized due to their low sensitivity for Left Ventricular Hypertrophy diagnosis compared to echocardiogram. This one, however, is not available in primary health care centers to all hypertensive population.
  
  
  OBJECTIVE
  To evaluate whether the association chest radiography-electrocardiogram provides the accuracy to justify its use in left ventricular hypertrophy detection in hypertensive patients, as well as the usefulness of the cardiothoracic ratio and oblique radiographs in relation to frontal and lateral views in evaluating dimensions of left cardiac chambers.
  
  
  METHODS
  This was a prospective study including 177 consecutive hypertensive patients through chest radiography, electrocardiogram and echocardiography. Accuracy test was used to compare these methods using echocardiography as gold standard.
  
  
  RESULTS
  The cardiothoracic ratio showed 17% sensitivity for detection of left ventricular hypertrophy, only indicating cardiac alterations at an advanced stage. Frontal plus lateral views showed sensitivity of 52%, which rose to 54% when chest radiography was associated with electrocardiogram. The oblique views did not significantly improve chest radiography accuracy. Chest radiography presented high specificity and elevated sensitivity for detection of aortal enlargement. Interestingly, this alteration was present in half of the hypertensive patients with left ventricular hypertrophy.
  
  
  CONCLUSIONS
  We conclude that the association chest radiography-electrocardiogram is useful for the screening of hypertensive patients for the diagnosis of left ventricular hypertrophy, especially if echocardiogram is unavailable.
authors.affiliation: Departamento de Doenças Tropicais e Diagnóstico por Imagem, Faculdade de Medicina de Botucatu, UNESP - Universidade Estadual Paulista, Brazil.
authors.forename: Sergio Marrone
authors.initials: SM
authors.lastname: Ribeiro
authors.forename: José
authors.initials: J
authors.lastname: Morceli
authors.forename: Renato Souza
authors.initials: RS
authors.lastname: Gonçalves
authors.forename: Roberto Jorge da Silva
authors.initials: RJ
authors.lastname: Franco
authors.forename: Francisco
authors.initials: F
authors.lastname: Habermann
authors.forename: Domingos Alves
authors.initials: DA
authors.lastname: Meira
authors.forename: Beatriz Bojikian
authors.initials: BB
authors.lastname: Matsubara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D055815:Young Adult