DIAGNOSTIC ACCURACY OF ELECTROCARDIOGRAPHY IN DIAGNOSIS OF LEFT ATRIAL ENLARGEMENT TAKING ECHOCARDIOGRAPHY AS THE GOLD STANDARD
Main Article Content
Keywords
Electrocardiography, Diagnostic Accuracy, Left Atrial Enlargement
Abstract
Introduction: Atrial enlargement is a marker of increased cardiovascular events. Anatomic left atrial (LA) enlargement (LAE) is a marker of left ventricular (LV) diastolic dysfunction and is associated with an abnormal stress test in subjects with known or suspected coronary artery disease. In addition, it is a predictor for the development of atrial fibrillation, congestive heart failure, stroke, increased cardiac mortality, incidence and survival after myocardial infarction and combined cardiovascular events.
Materials and Methods: The study was designed as a descriptive cross-sectional study with a duration of six months, conducted from October 2, 2021, to April 1, 2022, after the approval of the ethical committee .All patients who fulfilled the inclusion criteria and visited to NICVD, Karachi were included in the study. Informed consent was taken after explaining the procedure, risks and benefits of the study. All patients underwent electrocardiography and then echocardiography was done. The findings of electrocardiography and echocardiography were compared in order to evaluate diagnostic accuracy of electrocardiography. All the collected data were entered into the proforma attached at the end and used electronically for research purpose.
Results: Mean ± SD of age was 62.4±12.2 years. In distribution of gender, 95 (45.5%) patients were male while 114 (54.5%) were female. Diagnostic accuracy of electrocardiography was noted as 56.46% in diagnosis of left atrial enlargement with sensitivity 55.41%, specificity 57.04% PPV 41.41% and NPV 70.00% by using echocardiography as gold standard.
Conclusion: It is to be concluded that evaluating left atrial enlargement with electrocardiography did not proof helpful and comparable to echocardiography. Echocardiography should be done in each and every case to ensure adequate treatment.
Materials and Methods: The study was designed as a descriptive cross-sectional study with a duration of six months, conducted from October 2, 2021, to April 1, 2022, after the approval of the ethical committee .All patients who fulfilled the inclusion criteria and visited to NICVD, Karachi were included in the study. Informed consent was taken after explaining the procedure, risks and benefits of the study. All patients underwent electrocardiography and then echocardiography was done. The findings of electrocardiography and echocardiography were compared in order to evaluate diagnostic accuracy of electrocardiography. All the collected data were entered into the proforma attached at the end and used electronically for research purpose.
Results: Mean ± SD of age was 62.4±12.2 years. In distribution of gender, 95 (45.5%) patients were male while 114 (54.5%) were female. Diagnostic accuracy of electrocardiography was noted as 56.46% in diagnosis of left atrial enlargement with sensitivity 55.41%, specificity 57.04% PPV 41.41% and NPV 70.00% by using echocardiography as gold standard.
Conclusion: It is to be concluded that evaluating left atrial enlargement with electrocardiography did not proof helpful and comparable to echocardiography. Echocardiography should be done in each and every case to ensure adequate treatment.
References
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11. Macruz, R., Perloff, J. K., & CASE, R. B. (1958). A method for the electrocardiographic recognition of atrial enlargement. Circulation, 17(5), 882-889.
12. Kasser, I., & Kennedy, J. W. (1969). The relationship of increased left atrial volume and pressure to abnormal P waves on the electrocardiogram. Circulation, 39(3), 339-343.
13. Soloff, L. A. (1958). Relationship of the P wave to left atrial volume in rheumatic heart disease with mitral steno-sis. American Journal of the Medical Sciences, 236, 290-297.
14. Cafka, M., Rroji, M., Seferi, S., Barbullushi, M., Burazeri, G., Spahia, N., & Goda, A. (2016). Inflammation, left ventricular hypertrophy, and mortality in end-stage renal disease.
15. Foppa, M., Duncan, B. B., & Rohde, L. E. (2005). Echocardiography-based left ventricular mass estimation. How should we define hypertrophy?. Cardiovascular Ultrasound, 3, 1-13.
16. Cuspidi, C., Facchetti, R., Sala, C., Bombelli, M., Tadic, M., Grassi, G., & Mancia, G. (2016). Do combined electrocardiographic and echocardiographic markers of left ventricular hypertrophy improve cardiovascular risk estimation?. The Journal of Clinical Hypertension, 18(9), 846-854.
17. Barnes, M. E., Miyasaka, Y., Seward, J. B., Gersh, B. J., Rosales, A. G., Bailey, K. R., ... & Tsang, T. S. (2004, August). Left atrial volume in the prediction of first ischemic stroke in an elderly cohort without atrial fibrillation. In Mayo Clinic Proceedings (Vol. 79, No. 8, pp. 1008-1014). Elsevier.\
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19. Møller, J. E., Hillis, G. S., Oh, J. K., Seward, J. B., Reeder, G. S., Wright, R. S., ... & Pellikka, P. A. (2003). Left atrial volume: a powerful predictor of survival after acute myocardial infarction. Circulation, 107(17), 2207-2212.
2. Hoit, B. D. (2005). Assessing atrial mechanical remodeling and its consequences. Circulation, 112(3), 304-306.
3. Cuspidi, C., Negri, F., Sala, C., Valerio, C., & Mancia, G. (2012). Association of left atrial enlargement with left ventricular hypertrophy and diastolic dysfunction: a tissue Doppler study in echocardiographic practice. Blood Pressure, 21(1), 24-30.
4. Alingandula, A. (2016). Detection of Left Atrial Enlargement by Echocardiography and Electrocardiogram. International Journal of Scientific Study, 4, 1-5.
5. Ancona, R., Comenale Pinto, S., Caso, P., D’Andrea, A., Di Salvo, G., Arenga, F., & Calabrò, R. (2014). Left atrium by echocardiography in clinical practice: from conventional methods to new echocardiographic techniques. The Scientific World Journal, 2014.
6. Lee, K. S., Appleton, C. P., Lester, S. J., Adam, T. J., Hurst, R. T., Moreno, C. A., & Altemose, G. T. (2007). Relation of electrocardiographic criteria for left atrial enlargement to two-dimensional echocardiographic left atrial volume measurements. The American Journal of Cardiology, 99(1), 113-118.
7. Cuspidi, C., Rescaldani, M., & Sala, C. (2013). Prevalence of echocardiographic left-atrial enlargement in hypertension: a systematic review of recent clinical studies. American Journal of Hypertension, 26(4), 456-464.
8. Batra, M. K., Khan, A., Farooq, F., Masood, T., & Karim, M. (2018). Assessment of electrocardiographic criteria of left atrial enlargement. Asian Cardiovascular and Thoracic Annals, 26(4), 273-276.
9. Santos, J. P. A. D., Ribeiro, A. L. P., Andrade-Junior, D., & Marcolino, M. S. (2017). Prevalence of electrocardiographic abnormalities in primary care patients according to sex and age group. A retrospective observational study. Sao Paulo Medical Journal, 136, 20-28.
10. Hazen, M. S., Marwick, T. H., & Underwood, D. A. (1991). Diagnostic accuracy of the resting electrocardiogram in detection and estimation of left atrial enlargement: an echocardiographic correlation in 551 patients. American Heart Journal, 122(3), 823-828.
11. Macruz, R., Perloff, J. K., & CASE, R. B. (1958). A method for the electrocardiographic recognition of atrial enlargement. Circulation, 17(5), 882-889.
12. Kasser, I., & Kennedy, J. W. (1969). The relationship of increased left atrial volume and pressure to abnormal P waves on the electrocardiogram. Circulation, 39(3), 339-343.
13. Soloff, L. A. (1958). Relationship of the P wave to left atrial volume in rheumatic heart disease with mitral steno-sis. American Journal of the Medical Sciences, 236, 290-297.
14. Cafka, M., Rroji, M., Seferi, S., Barbullushi, M., Burazeri, G., Spahia, N., & Goda, A. (2016). Inflammation, left ventricular hypertrophy, and mortality in end-stage renal disease.
15. Foppa, M., Duncan, B. B., & Rohde, L. E. (2005). Echocardiography-based left ventricular mass estimation. How should we define hypertrophy?. Cardiovascular Ultrasound, 3, 1-13.
16. Cuspidi, C., Facchetti, R., Sala, C., Bombelli, M., Tadic, M., Grassi, G., & Mancia, G. (2016). Do combined electrocardiographic and echocardiographic markers of left ventricular hypertrophy improve cardiovascular risk estimation?. The Journal of Clinical Hypertension, 18(9), 846-854.
17. Barnes, M. E., Miyasaka, Y., Seward, J. B., Gersh, B. J., Rosales, A. G., Bailey, K. R., ... & Tsang, T. S. (2004, August). Left atrial volume in the prediction of first ischemic stroke in an elderly cohort without atrial fibrillation. In Mayo Clinic Proceedings (Vol. 79, No. 8, pp. 1008-1014). Elsevier.\
18. Patel, D. A., Lavie, C. J., Milani, R. V., Shah, S., & Gilliland, Y. (2009). Clinical implications of left atrial enlargement: a review. Ochsner Journal, 9(4), 191-196.
19. Møller, J. E., Hillis, G. S., Oh, J. K., Seward, J. B., Reeder, G. S., Wright, R. S., ... & Pellikka, P. A. (2003). Left atrial volume: a powerful predictor of survival after acute myocardial infarction. Circulation, 107(17), 2207-2212.
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Published
Apr 10, 2024
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How to Cite
Zohaib Altaf Chughtai, Munazza Nazir, Saba Kabir, Sohail Khan Raja, Intafada Aslam, Zarnab Munir, & Sehrish Shafeeq. (2024). DIAGNOSTIC ACCURACY OF ELECTROCARDIOGRAPHY IN DIAGNOSIS OF LEFT ATRIAL ENLARGEMENT TAKING ECHOCARDIOGRAPHY AS THE GOLD STANDARD. Journal of Population Therapeutics and Clinical Pharmacology, 31(4), 455–462. https://doi.org/10.53555/jptcp.v31i4.5519
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Author Biographies
Zohaib Altaf Chughtai
Cardiologist: Cardiac Hospital Bank Road Muzaffarabad AJK
Munazza Nazir
Associate Professor Medicine: AJKMC Muzaffarabad AJK
Saba Kabir
Medical Officer: Cardiac Hospital Bank road Muzaffarabad AJK
Sohail Khan Raja
HOD Pulmonology AIMS Muzaffarabad, Assistant Professor AJKMC, Muzaffarabad
Intafada Aslam
Medical Specialist: AIMS Muzaffarabad
Zarnab Munir
Medical Officer: Cardiac Hospital Bank Road, Muzaffarabad
Sehrish Shafeeq
Department of Biochemistry, University of Karachi, Karcahi-75270, Pakistan