Left-ventricular hypertrophy in the elderly: Unreliability of ECG criteria in 477 subjects aged 65 years or more - The CArdiovascular STudy in the ELderly (CASTEL)

Aim: To evaluate the diagnostic reliability of the ECG diagnosis of left-ventricular hypertrophy (LVH) in a cohort of elderly subjects taken from a general population. Patients: The 447 subjects with perfect echocardiography and ECG results of the 2,254 included in the Cardiovascular Study in the Elderly. Methods: Sensitivity, specificity, positive and negative predictive value of the most commonly used ECG tests of LVH were calculated versus the gold standard, echocardiography. Results: All ECG tests had a very low sensitivity. Furthermore, except for the Cornell index and (at least in the normotensives) the Minnesota code, they were not able to demonstrate the higher prevalence of LVH in elderly females in comparison to males. The predictive value of ECG was constantly higher in males than females when negative; when positive, some tests were more predictive in males, some in females, and in others, equally predictive in both sexes. Conclusions: ECG is not a reliable method for screening LVH in elderly populations. Echocardiography and ECG give different information, and their reliability may be different if positive or negative.