ECG Criteria for Diagnosis of LV Hypertrophy

Study Questions:

Can new criteria improve the sensitivity of the electrocardiographic (ECG) diagnosis of left ventricular hypertrophy (LVH)?


The study was divided into two groups, a test and a validation cohort. In the test cohort, 94 patients were analyzed, including 47 with the diagnosis of hypertensive crisis and 47 with normal blood pressure at admission. Echocardiography was used to estimate LV mass index. Area under the curve (AUC) analysis was utilized for comparison of single and combined leads. The McNemar’s test was used to assess agreement between ECG criteria and LV mass index. The proposed ECG criterion involved measuring the amplitude of the deepest S wave in any single lead and adding it to the S wave amplitude of lead V4. Currently accepted LVH ECG criteria (Cornell voltage and Sokolow-Lyon) were used for comparison. The validation cohort consisted of 122 consecutive patients referred for echocardiography regardless of the admitting diagnosis.


The deepest S wave was the most accurate single lead measurement for the diagnosis of LVH (area under the curve, 0.80; p < 0.001). When both cohorts were analyzed, the criterion of deepest S wave plus the S wave in lead V4 (≥2.3 mV for women and ≥2.8 mV for men) outperformed Cornell voltage with a significantly higher sensitivity of 62% (confidence interval [CI], 50-72%) versus 35% (CI, 24-46%). The specificities of all tested criteria were ≥90%, with no significant differences among them.


The proposed criterion for the ECG diagnosis of LVH (deepest S wave plus S wave in lead V4 using the Devereux formula) improved the sensitivity and overall accuracy of the test.


Existing ECG criteria for the diagnosis of LVH have low test sensitivities. This study suggests that a simple ECG criterion for the diagnosis of LVH (the deepest S wave plus the S wave in lead V4 ≥2.3 mV for women and ≥2.8 mV for men) is more accurate and as specific as standard ECG criteria.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Echocardiography/Ultrasound, Hypertension

Keywords: Arrhythmias, Cardiac, Blood Pressure, Diagnostic Imaging, Echocardiography, Electrocardiography, Heart Failure, Hypertension, Hypertrophy, Left Ventricular, Sensitivity and Specificity

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