Relevance of the electrocardiogram in the diagnosis of left ventricular hypertrophy of patients on hemodialysis
Abstract
Introduction: Left ventricular hypertrophy (LVH) is the most frequent structural cardiac alteration in patients with chronic kidney disease on hemodialysis. The electrocardiogram is the initial diagnostic resource used in the dialysis units for identification.
Objective: To evaluate the usefulness of the electrocardiogram in the diagnosis of LVH in patients with chronic kidney disease on hemodialysis.
Method: A total of 80 patients on hemodialysis were studied. The sensitivity, specificity and predictive values of seven electrocardiographic criteria of LVH were analyzed and correlated with the echocardiographic findings.
Results: LVH was identified by the electrocardiogram in 33 hemodialysis patients (41% of cases). The electrocardiogram showed 50% of sensitivity, 82% of specificity and 87% of positive predictive value in the diagnosis of LVH. The Sokolow-Lyon voltage was the most useful criterion for the diagnosis of LVH, due to its higher sensitivity (43%), high specificity (86%) and positive predictive value (89%). The pattern of systolic overload of the left ventricular prevailed among the diagnostic criteria of the Romhilt-Estes score. The Sokolow-Lyon voltage was the most useful criterion for detecting concentric forms of hypertrophy, whereas the voltage criterion of the R wave in aVL was the most useful for detecting severe forms.
Conclusions: The electrocardiogram is a useful diagnostic tool to certify the existence of LVH in patients with chronic kidney disease on hemodialysis. Its diagnostic utility is greater when it comes to identify concentric and severe forms of LVH.
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