Diagnostic Capability and Influence Factors for a New Electrocardiogram Criterion in the Diagnosis of Left Ventricular Hypertrophy in a Chinese Population

Introduction: Based on a small sample of patients with hypertension, a few studies have reported that the newly proposed S-D + SV4 criterion for left ventricular hypertrophy (LVH) is better than traditional criteria. This study aimed to verify the diagnostic capability of the S-D + SV4 criterion in a Chinese population with or without hypertension and to analyze the factors affecting the diagnostic accuracy of LVH. Methods: A total of 248 patients with LVH or paroxysmal supraventricular tachycardia (PSVT) discharged from Fuwai Hospital from January 2010 to July 2018 were enrolled. Patients with LVH were diagnosed according to the left ventricular mass index calculated by the echocardiogram parameter as the gold standard in this study. The receiver operating curve (ROC) curve was performed to assess the diagnostic capability and cut-off values of the S-D + SV4, RavL + SV3, and SV1 + RV5/RV6 criteria for LVH. Then, multivariate logistic regression analyses were performed to in-vestigate the factors affecting the accuracy of the S-D + SV4 criterion. Results: There were 170 (68.5%) patients with hypertension and 110 (44.4%) with PSVT. According to echocardiography, 107 (43.1%) patients were diagnosed with LVH. The area under the curve (AUC) of the S-D + SV4 criterion was the largest compared with that of the RavL + SV3 and SV1 + RV5/RV6 criteria (AUC 0.765 vs. 0.718 vs. 0.713, respectively). The sex-specific S-D + SV4 criterion had the highest consistency with the gold standard (r = 0.532 +/- 0.054, p < 0.01), accompanied by the highest sensitivity (70.1%) and specificity (85.8%). The cut-off values of the sex-specific S-D + SV4 criterion for LVH were >= 2.65 mV (male)/2.15 mV (female). The left ventricular ejection fraction (LVEF; OR 0.920, 95% CI 0.882-0.959, p < 0.001) was significantly different between the S-D + SV4 criterion and the gold standard for LVH after adjusting for hypertension, PSVT history, body surface area, interventricular septum thickness, posterior wall thickness, and left ventricular internal diameter. Conclusion: The newly proposed S-D + SV4 criterion provides improved sensitivity and accuracy for the diagnosis of LVH in the Chinese population. A decrease in LVEF is an independent factor affecting the diagnostic accuracy of LVH.