Electrocardiographic Diagnosis of Left Ventricular Hypertrophy (LVH)

Sokolow-Lyon index:

There are two criteria with these widely used indices:

* Sum of S wave in V1 and R wave in V5 or V6 >/= 3.5 mV (35 mm)

and/or

* R wave in aVL >/= 1.1 mV (11 mm)

Romhilt-Estes point score system:

Probable left ventricular hypertrophy is diagnosed if 4 points are present and definite left ventricular hypertrophy is diagnosed if 5 or more points are present.

 

Criterion 

 Points

Any limb R wave or S wave >/=2.0 mV (20 mm)

OR S in V1 or S in V2 >/= 3.0 mV (30 mm)

OR R in V5 or R in V6 >/= 3.0 mV (30 mm)

 

3

ST-T wave changes typical of LVH

Taking digitalis

Not taking digitalis

 

1

3

Left atrial abnormality

P terminal force in V1 is 1 mm or more in depth with a duration >/= 40 ms (0.04 sec)

 

3

Left axis deviation >/= -30ª

2

QRS duration >/= 90 ms

1

Intrinsicoid deflection in V5 or V6 >/= 50 ms (0.05 sec) *

1

 

* Intrinsicoid deflection is defined as interval between beginning of QRS interval and the peak of the R wave

Cornell voltage criteria – These more recent criteria are based upon echocardiographic correlative studies designed to detect a left ventricular mass index >132 g/m2 in men and >109 g/m2 in women.

  • For men: S in V3 plus R in aVL >2.8 mV (28 mm)

  • For women: S in V3 + R in aVL >2.0 mV (20 mm)

Cornell voltage-duration measurement

  • QRS duration×Cornell Voltage > 2440 ms × mV

Sensitivity and specificity for selected ECG criteria of LVH

 Criterion

 Sensitivity (%)

Specificity (%) 

 Sokolow Lyon Voltage

 22

 100

 Cornell Voltage Criteria

 42

 96

 Cornell Voltage Duration Criteria

 51

 95

 RaVL > 11 mm

 11

 100

 Romhilt-Estes > 4 points

 54

 85

 Romhilt-Estes > 5 points

 33

 94

 

Scott’s criteria for LVH

Limbs leads:

  • R in 1 + S in 3 more than 25 mm
  • R in aVL more than 7.5 mm

Chest leads:

  • S in V1 or V2 + Rin V5 or V6 ,ore than 35 mm
  • R in V5 or V6 more than 26
  • R + S in any V lead more than 45 mm

References:

  1. de Vries SO, Heesen WF, Beltman FW, Kroese AH, May JF, Smit AJ, Lie KI. Prediction of the left ventricular mass from the electrocardiogram in systemic hypertension. Am J Cardiol. 1996 May 1;77(11):974-8. [Medline]

  2. Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P. Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings. Circulation. 1987 Mar;75(3):565-72. [Medline]

  3. Okin PM, Roman MJ, Devereux RB, Kligfield P. Gender differences and the electrocardiogram in left ventricular hypertrophy. Hypertension. 1995 Feb;25(2):242-9. [Medline]

 

Created: January 03, 2006

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