The Diagnostic Value of the Deepest S Wave in 12-Lead Electrocardiogram to Elderly Patients with Essential Hypertension and Left Ventricular Hypertrophy

OBJECTIVE: This study aims to explore the diagnostic value of the deepest S wave (S(D)) in elderly patients with essential hypertension and left ventricular hypertrophy (LVH). METHODS: A retrospective study was conducted in elderly patients with essential hypertension from October 2020 to December 2021. The 12-lead electrocardiogram (ECG) examination was carried out at the time of admission. Echocardiography was performed to estimate left ventricular mass (LVM) and the left ventricular muscle mass index (LVMI) was adjusted by the body surface area (BSA). The Receiver Operating Characteristic (ROC) curve for diagnosing hypertension with LVH was drawn, the cut-off value was determined according to the Youden index, and the area under the curve (AUC) was calculated. The diagnostic values of S(D), S(D)+S(v4), r(avl)+S(v3), and S(v1)+R(v5) were compared. RESULTS: The results of S(D), S(D)+S(v4), R(avL)+S(v3), and S(v1)+R(v5) in the Study group were 2.03 (1.56–2.57) mV, 3.09 (2.38–3.98) mV, 2.19 (1.46–2.78) mV, and 3.38 (2.67–4.19) mV respectively, which were all higher than those in the Control group [0.93 (0.68–1.23) mV, 1.37 (1.32–2.18) mV, 1.03 (0.68–1.46) mV, and 2.28 (1.67–2.67) mV], P<0.001. Compared with the ROC curved by S(D)+S(v4), R(avL)+S(v3), and S(v1)+R(v5), the AUC of the ROC curved by S(D) was [0.887, 95% CI (0.837–0.927)], and the cut-off value was 1.298 with the Sensitivity = 86.03 and Specificity = 86.59 in diagnosing essential hypertension with LVH. In female patients, the AUC of the ROC curved by S(D) was [0.891, 95% CI (0.841–0.934)], and the cut-off value was 1.304 with the Sensitivity of 89.32% and Specificity of 88.67%, which were all higher than those in male patients [AUC = 0.887, 95% CI (0.828–0.943); cut-off value = 1.288; Sensitivity = 82.12%, and Specificity = 84.22%]. CONCLUSION: ECG can effectively diagnose elderly patients with essential hypertension and LVH and the diagnostic value of S(D) and S(D)+S(v4) are higher than the current Cornell criteria and Sokolow–Lyon criteria.