Development and validation of a rapid visual technique for left ventricular hypertrophy detection from the electrocardiogram

Sulaiman Somani; J Weston Hughes; Euan A Ashley; Ronald M Witteles; Marco V Perez

doi:10.3389/fcvm.2023.1251511

Development and validation of a rapid visual technique for left ventricular hypertrophy detection from the electrocardiogram

Front Cardiovasc Med. 2023 Aug 23:10:1251511. doi: 10.3389/fcvm.2023.1251511. eCollection 2023.

Authors

Sulaiman Somani^{1

2}, J Weston Hughes^{3

4}, Euan A Ashley³, Ronald M Witteles³, Marco V Perez³

Affiliations

¹ Division of Internal Medicine, Department of Medicine, Stanford University, Stanford, CA, United States.
² Stanford Cardiovascular Institute, Stanford, CA, United States.
³ Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, United States.
⁴ Department of Computer Science, Stanford University, Stanford, CA, United States.

Abstract

Introduction: Left ventricular hypertrophy (LVH) detection techniques on by electrocardiogram (ECG) are cumbersome to remember with modest performance. This study validated a rapid technique for LVH detection and measured its performance against other techniques.

Methods: This was a retrospective cohort study of patients at Stanford Health Care who received ECGs and resting transthoracic echocardiograms (TTE) from 2006 through 2018. The novel technique, Witteles-Somani (WS), assesses for S- and R-wave overlap on adjacent precordial leads. The WS, Sokolow-Lyon, Cornell, and Peguero-Lo Presti techniques were algorithmically implemented on ECGs. Classification metrics, receiver-operator curves, and Pearson correlations measured performance. Age- and sex-adjusted Cox proportional hazard models evaluated associations between incident cardiovascular outcomes and each technique.

Results: A total of 53,333 ECG-TTE pairs from 18,873 patients were identified. Of all ECG-TTE pairs, 21,638 (40.6%) had TTE-diagnosed LVH. The WS technique had a sensitivity of 0.46, specificity of 0.66, and AUROC of 0.56, compared to Sokolow-Lyon (AUROC 0.55), Cornell (AUROC 0.63), and Peguero-Lo Presti (AUROC 0.63). Patients meeting LVH by WS technique had a higher risk of cardiovascular mortality [HR 1.18, 95% CI (1.12, 1.24), P < 0.001] and a higher risk of developing any cardiovascular disease [HR 1.29, 95% CI (1.22, 1.36), P < 0.001], myocardial infarction [HR 1.60, 95% CI (1.44, 1.78), P < 0.005], and heart failure [HR 1.24, 95% CI (1.17, 1.32), P < 0.001].

Conclusions: The WS criteria is a rapid visual technique for LVH detection with performance like other LVH detection techniques and is associated with incident cardiovascular outcomes.

Keywords: ECG; LVH; LVH detection; echo; left ventricular hypertrophy.

Grants and funding

MVP is employed as a consult by Apple Inc and receives funding from NIH/NHLBIR01HL136390. All authors declare that the research was conducted in the absence of any relevant commercial or financial relationships that could be construed as potential conflicts of interest.