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Electrocardiograph Errors Frequent in Diagnosing Left Ventricular Hypertrophy: Presented at AHA
By Ed Susman
ORLANDO, Fla -- November 20, 2009 -- A diagnosis of left ventricular hypertrophy identified with an electrocardiograph (ECG) is often wrong or inconclusive, often leading to a repeat, confirmatory test, researchers stated here at the American Heart Association (AHA) Scientific Sessions 2009.
"We have found that findings of left ventricular hypertrophy are very often wrong when it is detected on an electrocardiograph," said Mohamad Sinno, MD, Henry Ford Hospital, Detroit, Michigan, on November 17.
The electrical measurements on an ECG can often mislead physicians in diagnosing left ventricular hypertrophy, causing other screening tests to be ordered before a definitive conclusion can be made.
The study found a false-positive reading in 77% to 82% of patients screened by ECG and a false-negative reading in 6% to 7% of the same patient population.
The researchers reviewed data collected from 353 consecutive patients who underwent coronary computed tomography (CT) angiography for various clinical reasons.
"We found that 28 patients [7.9%] had left ventricular hypertrophy by CT and 57 patients [16.1%] had left ventricular hypertrophy by any ECG criteria," Dr. Sinno said. Using cardiac CT as the gold standard, ECG criteria for diagnosing left ventricular hypertrophy have poor sensitivity.
"Generally, what our study shows is that if a doctor says the ECG doesn't indicate left ventricular hypertrophy, then the patient most likely doesn't have that condition," Dr. Sinno said.
However, if the ECG reading indicates left ventricular hypertrophy is present then the patient needs further testing, either with CT, cardiac magnetic resonance imaging (MRI), or ultrasound to confirm the finding, according to Dr. Sinno.
He suggested that cardiac CT has emerged as the gold standard because of technical difficulties in interpreting ultrasound and the expense of MRI when compared with CT.
Funding for this study was provided by Henry Ford Hospital.
[Presentation title: Diagnostic Accuracy of Electrocardiographic Criteria for Left Ventricular Hypertrophy: Comparison With Computed Tomography. Abstract 2657]
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