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Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review
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2007 (English)In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 335, no 7622, 711-714C p.Article, review/survey (Refereed) Published
Abstract [en]

OBJECTIVE: To review the accuracy of electrocardiography in screening for left ventricular hypertrophy in patients with hypertension. DESIGN: Systematic review of studies of test accuracy of six electrocardiographic indexes: the Sokolow-Lyon index, Cornell voltage index, Cornell product index, Gubner index, and Romhilt-Estes scores with thresholds for a positive test of > or =4 points or > or =5 points. DATA SOURCES: Electronic databases ((Pre-)Medline, Embase), reference lists of relevant studies and previous reviews, and experts. STUDY SELECTION: Two reviewers scrutinised abstracts and examined potentially eligible studies. Studies comparing the electrocardiographic index with echocardiography in hypertensive patients and reporting sufficient data were included. DATA EXTRACTION: Data on study populations, echocardiographic criteria, and methodological quality of studies were extracted. DATA SYNTHESIS: Negative likelihood ratios, which indicate to what extent the posterior odds of left ventricular hypertrophy is reduced by a negative test, were calculated. RESULTS: 21 studies and data on 5608 patients were analysed. The median prevalence of left ventricular hypertrophy was 33% (interquartile range 23-41%) in primary care settings (10 studies) and 65% (37-81%) in secondary care settings (11 studies). The median negative likelihood ratio was similar across electrocardiographic indexes, ranging from 0.85 (range 0.34-1.03) for the Romhilt-Estes score (with threshold > or =4 points) to 0.91 (0.70-1.01) for the Gubner index. Using the Romhilt-Estes score in primary care, a negative electrocardiogram result would reduce the typical pre-test probability from 33% to 31%. In secondary care the typical pre-test probability of 65% would be reduced to 63%. CONCLUSION: Electrocardiographic criteria should not be used to rule out left ventricular hypertrophy in patients with hypertension.

Place, publisher, year, edition, pages
2007. Vol. 335, no 7622, 711-714C p.
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Medical and Health Sciences
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URN: urn:nbn:se:uu:diva-14400DOI: 10.1136/bmj.39276.636354.AEISI: 000250156800033PubMedID: 17726091OAI: oai:DiVA.org:uu-14400DiVA: diva2:42170
Available from: 2008-01-30 Created: 2008-01-30 Last updated: 2017-12-11Bibliographically approved

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Sundström, Johan

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