title: Electrocardiogram Performance in the Diagnosis of Left Ventricular Hypertrophy in Hypertensive Patients With Left Bundle Branch Block.
abstract: BACKGROUND
  Left ventricular hypertrophy (LVH) is an important risk factor for cardiovascular events, and its detection usually begins with an electrocardiogram (ECG).
  
  
  OBJECTIVE
  To evaluate the impact of complete left bundle branch block (CLBBB) in hypertensive patients in the diagnostic performance of LVH by ECG.
  
  
  METHODS
  A total of 2,240 hypertensive patients were studied. All of them were submitted to an ECG and an echocardiogram (ECHO). We evaluated the most frequently used electrocardiographic criteria for LVH diagnosis: Cornell voltage, Cornell voltage product, Sokolow-Lyon voltage, Sokolow-Lyon product, RaVL, RaVL+SV3, RV6/RV5 ratio, strain pattern, left atrial enlargement, and QT interval. LVH identification pattern was the left ventricular mass index (LVMI) obtained by ECHO in all participants.
  
  
  RESULTS
  Mean age was 11.3 years ± 58.7 years, 684 (30.5%) were male and 1,556 (69.5%) were female. In patients without CLBBB, ECG sensitivity to the presence of LVH varied between 7.6 and 40.9%, and specificity varied between 70.2% and 99.2%. In participants with CLBBB, sensitivity to LVH varied between 11.9 and 95.2%, and specificity between 6.6 and 96.6%. Among the criteria with the best performance for LVH with CLBBB, Sokolow-Lyon, for a voltage of ≥ 3,0mV, stood out with a sensitivity of 22.2% (CI 95% 15.8 - 30.8) and specificity of 88.3% (CI 95% 77.8 - 94.2).
  
  
  CONCLUSIONS
  In hypertensive patients with CLBBB, the most often used criteria for the detection of LVH with ECG showed significant decrease in performance with regards to sensitivity and specificity. In this scenario, Sokolow-Lyon criteria with voltage ≥3,0mV presented the best performance.
authors.affiliation: Universidade Federal de São Paulo, Brazil.
authors.forename: Paula Freitas Martins
authors.initials: PF
authors.lastname: Burgos
authors.affiliation: Universidade Federal de São Paulo, Brazil.
authors.forename: Bráulio
authors.initials: B
authors.lastname: Luna Filho
authors.affiliation: Universidade Federal de São Paulo, Brazil.
authors.forename: Francisco de Assis
authors.initials: FA
authors.lastname: Costa
authors.affiliation: Universidade Federal de São Paulo, Brazil.
authors.forename: Maria Teresa Nogueira
authors.initials: MT
authors.lastname: Bombig
authors.affiliation: Universidade Federal do Pará, Belém, PA, Brazil.
authors.forename: Dilma de
authors.initials: D
authors.lastname: Souza
authors.affiliation: Universidade Federal de São Paulo, Brazil.
authors.forename: Henrique Tria
authors.initials: HT
authors.lastname: Bianco
authors.affiliation: Universidade Federal de São Paulo, Brazil.
authors.forename: Japy Angelini
authors.initials: JA
authors.lastname: Oliveira Filho
authors.affiliation: Universidade Federal de São Paulo, Brazil.
authors.forename: Maria Cristina de Oliveira
authors.initials: MC
authors.lastname: Izar
authors.affiliation: Universidade Federal de São Paulo, Brazil.
authors.forename: Francisco Antonio Helfenstein
authors.initials: FA
authors.lastname: Fonseca
authors.affiliation: Universidade Federal de São Paulo, Brazil.
authors.forename: Rui
authors.initials: R
authors.lastname: Póvoa
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000175:diagnosis / Q000503:physiopathology*; D004452:Echocardiography; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors