Usefulness and limitation of electrocardiography for diagnosis of left ventricular hypertrophy in the elderly

Background To investigate the usefulness of electrocardiography (EGG) in the diagnosis of left ventricular hypertrophy in elderly subjects, we evaluated consecutive patients who were admitted to hospital and compared 102 elderly patients (greater than or equal to 60 years) with 99 patients aged younger than 60 years. Methods Left ventricular hypertrophy was diagnosed using echocardiography. We investigated 14 ECG criteria for the diagnosis of left ventricular hypertrophy and examined their sensitivity, specificity and accuracy. Results Precordial voltage criteria, SV1 + RV(5) or RV(6) less than or equal to 35 mm, had the highest accuracy in all patients (55.7%) and elderly patients (54.9%). In elderly patients, Romhilt-Estes score greater than or equal to 5 also had a high accuracy (52.0%). The accuracy of RV(5)/RV(6) greater than or equal to 0.9 in the elderly patients (53.9%) was higher than that in the younger group (42.4%). The accuracy of SV1 + RV(5) or RV(6) greater than or equal to 35 mm (66.7%). Romhilt-Estes score greater than or equal to 5 (74.1%), and RV(5)/RV(6) greater than or equal to 0.9 (61.1%) were high in normotensive elderly patients. In contrast, neither accuracy of LVH criteria was less than 50% in hypertensive elderly patients. Conclusion In the elderly the criteria of SV1 + RV(5) or RV(6), Romhilt-Estes score and RV(6)/RV(5) were useful for the diagnosis of left ventricular hypertrophy on EGG. In hypertensive elderly patients, however, echocardiography is required to detect LVH as a result of the low accuracy and low sensitivity of EGG.