Sensitivity and specificity of ECG criteria in the diagnosis of left atrium enlargement in patients with arterial hypertension
Abstract. Left atrium (LA) enlargement according to echocardiography (EchoCG) data is an early manifestation of organ damage in arterial hypertension (AH) and is a predictor of atrial fibrillation (AF).Bursikov A.V., Abrashkina E.D., Galkina M.A.
The aim: to determine the sensitivity and specificity of electrocardiographic (ECG) criteria in the diagnosis of LA enlargement established by transthoracic echocardiography.
Material and methods. 40 patients with stage 1–2 arterial hypertension were examined: 25 patients with left atrial volume index (LAVI) ≥ 34 ml/m2 and 15 with LAVI ≤ 33.9 ml/m2. In addition to a general clinical examination, all patients underwent a comparative analysis of ECG and EchoCG parameters reflecting LA enlargement: LAVI, anteroposterior size, and LA length were assessed by EchoCG, while R wave duration, its shape, duration of the negative portion of R wave in lead V1 (RV1), and the Macruz index were assessed by ECG. The sensitivity and specificity of ECG signs in diagnosing LA enlargement established by echocardiography were determined using ROC analysis.
Results. In patients with arterial hypertension, the LA length was more often increased (77.5%) than its anteroposterior size (47.5%). The sensitivity of ECG signs of LA enlargement (R wave duration, its double hump, RV1 wave with a widened negative phase) did not always exceed 50%, but a number of ECG parameters were highly specific concerning both LA volume and linear dimensions.
Conclusion. The presence of RV1 wave with a wide negative phase is the most specific sign of an increase in both LA volume and its anteroposterior size and length. Highly specific signs of LA length enlargement include double hump of R wave, presence of RV1 wave with a widened negative phase and an increase of Macruz index.
Keywords
electrocardiographic criteria of left atrium enlargement
sensitivity and specificity
left atrium enlargement
arterial hypertension
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About the Authors
Alexander V. Bursikov, MD, Dr. Sci. (Medicine), associate professor, head of the Department of propaedeutics of internal diseases, Ivanovo State Medical University of the Ministry of Healthcare of Russia. Address: 153012, Ivanovo, 8 Sheremetevsky Avenue.E-mail: a.v.bursikov@mail.ru
ORCID: https://orcid.org/ 0000-0002-9971-6468
Elena D. Abrashkina, MD, PhD (Medicine), associate professor of the Department of propaedeutics of internal diseases, Ivanovo State Medical University of the Ministry of Healthcare of Russia. Address: 153012, Ivanovo, 8 Sheremetevsky Avenue.
E-mail: elenaabrashkina@mail.ru
ORCID: https://orcid.org/ 0000-0002-6675-3641
Marina A. Galkina, MD, doctor of functional diagnostics at Ivanovo Veterans Hospital. Address: 153002, Ivanovo, 9 Demidova St.
E-mail: galkina-marina3@yandex.ru
ORCID: https://orcid.org/ 0009-0008-1879-7640
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