PERFORMANCE OF THE PEGUERO-LO PRESTI CRITERIA FOR THE DIAGNOSIS OF LEFT VENTRICULAR HYPERTROPHY IN PATIENTS WITH CARDIAC DISEASE IN IBADAN, NIGERIA.

---

O.S Ogah^1,2; A. Adebiyi^1,2, O.A Orimolade¹, T.M Akinosi⁴, S. Aborisade¹, C.E Okorie¹, A. Awe¹, A.J Fadare¹, O.P Attah⁴, C.A Nwamadiegesi⁴, O.V Adeyeye⁴, C.H Ezeh⁴, S.O Digwu⁴, F.E Obiekwe⁴, C.M Ogah², C.S Asogwa⁴,M. Okeke⁵

1. Department of Medicine, University College Hospital, Ibadan, Nigeria.
2. Department of Medicine, University of Ibadan, Ibadan, Nigeria.
3. Alexander Brown Hall, College of Medicine, University of Ibadan, Oyo State.

Abstract

Background: Many criteria have been developed to predict left ventricular hypertrophy using an electrocardiogram (ECG). However, one major common limitation of all has been their low sensitivity. Recently, a novel criterion has been proposed, which is believed to have higher sensitivity without a compromise in specificity.

Objective: Therefore, in our study, we aimed to test this novel ECG criterion prospectively in large, unselected cardiac patients in Ibadan, Nigeria.

Methods: Patients who were referred to our echocardiography laboratory due to various aetiologies were prospectively enrolled. The novel Peguero-Lo Presti criterion was assessed along with other established ECG criteria. The left ventricular mass index was calculated using echocardiography. The performance of each index was evaluated.

Results: Overall, 336 patients were included in the final analysis. The mean age was 57.94±14.98 and 178 (53.0%) of them were males. The sensitivity and specificity of the Peguero-Lo Presti criterion were 59% and 66%, respectively. Although the highest sensitivity belonged to the Peguero-Lo Presti criterion, in ROC analysis, it showed modest predictive capability, which was similar to the established Cornell voltage criterion.

Conclusion: Although this novel criterion had higher sensitivity, the overall performance was similar to the current indices. Further adjustments, particularly based on age and body mass index, may yield better results.

Keywords: Left ventricular hypertension, Electrocardiography, Peguero-Lo presti criterion, Cornell voltage criterion.

Introduction

Left ventricular hypertrophy (LVH) is a well-established predictor of incident cardiovascular event.1,2 It is associated with increased morbidity and mortality.^1,2 The establishment of the diagnosis of LVH is often by echocardiography, although cardiac magnetic resonance imaging (MRI) is the gold standard.^{3, 4} In clinical practice, 12-lead ECG is usually employed in the assessment of LVH. This is because 12-lead is cheap, readily available, and cost-effective. At the moment there are over thirty ECG criteria for LVH.^5,6 Many of these have limited sensitives and specificities. Thus, the search for better 12-lead ECG criteria for the diagnosis of LVH is still being investigated. Currently, the Sokolow-Lyon⁷ and Cornell criteria⁸ are most commonly used for the diagnosis of LVH in the medical literature. In many studies, the latter performs better than the former.⁹ However, though the Cornell criteria have a specificity as high as 90%, its sensitivity is poor (20-40%).¹⁰

It is, therefore, necessary to explore a criterion whose sensitivity and specificity are good.

Not long ago, Peguero et al.¹¹ published a criterion with improved sensitivity and specificity. The criterion is measured by the addition of the maximum S-wave in any lead and the S-wave in lead V4 (SV4) This is believed to improve sensitivity without effects on the specificity. The criterion has been tested in a few populations and scarcely in native Africans.¹²

Therefore, this study aims to test the sensitivity and specificity of this novel criterion in the Nigerian population and compare it with the Cornell and Sokolow-Lyon criteria.