OBJECTIVES: To determine the sensitivity and specificity of the electrocardiographic (ECG) criteria for determining left ventricular hypertrophy (LVH) among male and female Filipino patients. To determine which combination of the ECG criteria is most sensitive and specific.

STUDY DESIGN: Retrospective Case-Control Validation Study. SETTING: University of Santo Tomas Hospital (GSTH) Heart Station

METHODOLOGY: All adult patients seen at the Heart Station of the GSTH for echocardiography and electrocardiography from June to September 2006 were included. Echocardiograhic records were reviewed including age, sex, weight, height, BSA, LV mass and index. The Sokolow-Lyon, Sokolow-Lyon Rappaport, Cornell, White Bock, Romhilt - Estes scoring were compared with LV mass corrected for BSA, using the Feigenbaum curve.

RESULTS: There were 183 patients (93 males and 90 females) included in the final analysis. Mean age is 57 + 16.2 years. Mean BSA, LV mass and LV mass index were statistically higher in males. The Sokolow-Lyon Rappaport had the greatest sensitivity (73 percent ) and specificity (92 percent) in male subjects. Both the Sokolow-Lyon Rappaport and Cornell criteria had the highest sensitivity (60 percent) and specificity (98.6 percent) among female subjects. The White-Bock criteria was the least sensitive (0 percent) for both populations and the Romhilt Estes scoring, the least specific(82 percent in males and 89.3 percent in females) for both populations.

CONCLUSION: The Sokolow-Lyon Rappaport was the most sensitive and specific in determining LVH among male Filipino patients. The Cornell voltage duration product and Sokolow-Lyon Rappaport had the highest sensitivity and specificity among female Filipino patients. Among all the combinations of the criteria, the Cornell and White Bock criteria had the highest sensitivity and specificity. (Author)

Electrocardiography ; Hypertrophy ; Hypertrophy, Left Ventricular

BACKGROUND:?There is a critical relationship of time to treatment and myocardial salvage in the patient with acute myocardial infarction (AMI). As the proven beneficial management options for AMI have been extensively studied, the challenge lies in developing a process that minimizes pre-hospital delays, delays in assessment and initiation of reperfusion therapy. A greater emphasis on pre-hospital care has more potential in reducing mortality from acute MI than further development of hospital based treatments.

OBJECTIVE:?This study identifies the socio-demographic risk factors in patients with acute coronary syndrome and correlate them with pre-hospital delay. This response time to treatment is then correlated with the clinical outcome.

STUDY DESIGN:?Clinical Descriptive Study

METHODS:?Adult patients with diagnosis of acute coronary syndrome at the ICU setting of the USTH were sampled. Charts were reviewed and socio-demographic profiles identified. Pre-hospital delay from the onset of chest pain were correlated with these socio-demographic factors using multiple regression logistic regression. Chi square test was used to determine association between pre-hospital delay and clinical outcome.

RESULTS:?The study sample consisted of 220 patients with acute coronary disease. The sample population included 63% Non ST Elevation Myocardial Infarction (NSTEMI), 4% ST Elevation Myocardial Infarction (STEMI) and 33 percent with unstable angina. Male population accounted for 54% of the population. Thirty eight?percent(38%) of the population belonged to the 61.70 age group with mean age of 65 years old. The prevalence of hypertension (70%) and DM (41%) was high and about 30% of the population had prior history of coronary artery disease (CAD). About 35% reported family history of CAD and 41% had family history of DM. More than half of the population are smokers (55%). Majority of the patient population live within 10 kilometers from USTH (70%) while 28 patients (13%) came from the province. Thirty-eight percent (38%) sought consultation after two pain events, while only 4% came after more than 4 chest pain events. A significant number of population in the present series presented to the hospital delayed by more than four hours. Majority of the patients (40%), came in more than 6 hours. Twenty one percent (21%) came 2-4 hours while 30 percent came 4-6 hours from the onset of chest pain. The most common reason for the delay in seeking medical attention is financial limitation (36%), 31% had relief of chest pain by nitrates. Of the 220 included in the group, 50% had morbidity (such as development of acute renal failure, congestive heart failure), 41% had unremarkable outcome while there was 10% mortality noted. However in this study, we were not able to associate any socio-demographlc factors and the delay in time to treatment with the clinical outcome using available data and statistical.

CONCLUSION:?The results of this study demonstrate that patients with acute coronary event continue to exhibit prolonged delay in seeking medical care. This paper, Likewise, demonstrated that certain demographic and socioeconomic characteristics are associated with pre-hospital delay such as age, sex, history of CAD, hypertension and DM, proximity to the hospital, pain events prior to consultation and educational attainment. However, no correlation can be made between delay in time to treatment and clinical outcome.

Human ; Male ; Female ; St Elevation Myocardial Infarction ; Acute Coronary Syndrome ; Coronary Artery Disease ; Myocardial Infarction ; Hypertension ; Heart Failure