Valor del electrocardiograma en el diagnóstico de hipertrofia ventricular izquierda de pacientes en hemodiálisis

Ana M. Suárez Conejero, Yuliet Lemus Almaguer, Dulce M. Meirelis Delgado, Mariana Otero Suárez

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Resumen

Introducción: La hipertrofia ventricular izquierda (HVI) es la alteración estructural cardíaca más frecuente en pacientes con enfermedad renal crónica en hemodiálisis. El electrocardiograma es el medio diagnóstico inicial empleado en las unidades de diálisis para su identificación.

Objetivos: Evaluar la utilidad del electrocardiograma en el diagnóstico de HVI en pacientes con enfermedad renal crónica en hemodiálisis.

Método: Se estudiaron 80 pacientes en hemodiálisis. Se analizó la sensibilidad, especificidad y valores predictivos de siete criterios electrocardiográficos de HVI y se correlacionaron con los hallazgos ecocardiográficos.

Resultados: Se identificó HVI mediante el electrocardiograma en 33 pacientes hemodializados (41% de los casos). El electrocardiograma mostró 50% de sensibilidad, 82% de especificidad y 87% de valor predictivo positivo en el diagnóstico de HVI. El voltaje de Sokolow-Lyon fue el criterio más útil para el diagnóstico de HVI por su mayor sensibilidad (43%), alta especificidad (86%) y valor predictivo positivo (89%). El patrón de sobrecarga sistólica del ventrículo izquierdo predominó entre los criterios diagnósticos de la puntuación de Romhilt-Estes. El voltaje de Sokolow-Lyon fue el criterio más útil para detectar formas concéntricas de hipertrofia mientras que el criterio de voltaje de R en aVL resultó el más útil para detectar formas graves.

Conclusiones: El electrocardiograma es un medio diagnóstico útil para certificar la existencia de HVI en pacientes con enfermedad renal crónica en hemodiálisis. Su utilidad diagnóstica es mayor para identificar formas concéntricas y graves de HVI.

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