Sensitivity and specificity of ECG criteria of left atrial enlargement in comparison to cardiac magnetic resonance in patients with hypertrophic cardiomyopathy
More details
Hide details
Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw, Poland.
Mazowiecki Szpital Specjalistyczny, Radom, Poland
Department of Coronary Heart Disease and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
Public Health Department, Medical University of Bialystok, Bialystok, Poland.
Department of Cardiac Arrhythmia, Institute of Cardiology, Warsaw, Poland
Collegium Masoviense, Żyrardów, Poland
Łukasz A. Małek   

Kazury 1/13, 02-795 Warsaw, Poland
Publication date: 2016-12-15
Heart Beat 2016;1:1–5
In patients with hypertrophic cardiomyopathy (HCM) left atrial (LA) enlargement has been related to increased risk of sudden cardiac death. Cardiac magnetic resonance (CMR) is the method of choice in the assessment of LA size and volume. However, initial assessment of LA enlargement is often made by means of ECG criteria including P wave analysis in leads II and V1. The aim of the study was to assess the sensitivity and specificity of ECG criteria for LA enlargement in relation to CMR.

Material and methods:
The study included 236 patients (62.7% male, median age 47 years) with documented HCM and sinus rhythm on 12-lead ECG who underwent CMR study. ECGs were digitally analyzed for the following criteria: P wave duration in lead II >120 ms or area of negative P-terminal force in V1 > 40 LA volume index (LAVI) >53 ml/m2 was used as a cut-off value of LA enlargement in CMR studies.

LA enlargement on ECG was found in 109 patients (46.2%) and on CMR in 48 patients (20.3%). Sensitivity, specificity, positive and negative predictive values of LA enlargement based on P-wave characteristics in lead II were 54.1%, 67.4%, 36.7% and 80.8% and in lead V1 - 32.8%, 80.0%, 36.4% and 77.3%.

Current ECG criteria of LA enlargement have limited diagnostic value in detection of LA enlargement due to their low sensitivity and only moderate specificity.