Seamens’ Sign – New ECG Prediction Tool for LVH

Written by Nick Zelt

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The Seamens’ Sign performs better than commonly used criteria for ruling in left ventricular hypertrophy (LVH) by ECG.

Why does this matter?
Patients with LVH have increased mortality and a higher risk for cardiovascular disease, namely coronary artery disease. This is a diagnosis which can be detected on ECG and thus should be remarked upon in the context of the patient’s presentation and investigated as appropriate. Despite this, the diagnosis of LVH by ECG is complicated, challenging, and often inaccurate. These authors propose a quick and easy solution you can use on shift.

It’s clearly LVH. Can’t you see, man?
Seamens’ Sign asks only one question: Do the QRS complexes in two contiguous precordial leads touch or overlap? No numbers to memorize, no calipers required; you could answer this question at a glance without even putting on your reading glasses (see figure to try for yourself).

This was a retrospective study using the electronic health record of a quaternary care academic hospital to analyze 2,184 ECGs done as part of routine care in the emergency department. All ECGs were analyzed based on criteria commonly used to diagnose LVH, two Sokolow-Lyon criteria and the Cornell criteria as well Seamens’ sign. The results were compared with the gold-standard of transthoracic echocardiogram performed within 90 days of the ECG.

Seamens’ Sign test characteristics: Sensitivity: 0.11 (CI:0.09, 0.13); Specificity: 0.92 (CI:0.91, 0.94); PPV: 0.43 (CI:0.36, 0.51); NPV: 0.66 (CI:0.64, 0.68)

This resulted in Seamens’ Sign being non-inferior to all the other criteria (p <0.001) except the Cornell criteria for women (p=0.98). Interrater agreement was highest for Seamens’ sign, kappa = 0.9. This means that, at least for men, Seamens’ sign was the best test. Admittedly though, none of the tests are very good, and – if used as at all – should be used as rule-in tests.

From cited article: Standard 12-lead electrocardiogram demonstrating Seamens’ Sign with precordial QRS complexes overlapping and/or touching.

Editor’s note: I remember when you used to say this should be an ECG sign of LVH. This one’s for you, Chuck! ~Clay Smith

Source
Walker P, Jenkins CA, Hatcher J, Freeman C, Srica N, Rosell B, Hanna E, March C, Seamens C, Storrow A, McCoin N. Seamens’ Sign: a novel electrocardiogram prediction tool for left ventricular hypertrophy. PeerJ. 2022 May 31;10:e13548. doi: 10.7717/peerj.13548.

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