Unifying Concepts

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)


* 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.




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)


ST-T wave changes typical of LVH
Taking digitalis
Not taking digitalis


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


Left axis deviation >/= -30ª


QRS duration >/= 90 ms


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


* 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


 Sensitivity (%)

Specificity (%) 

 Sokolow Lyon Voltage



 Cornell Voltage Criteria



 Cornell Voltage Duration Criteria



 RaVL > 11 mm



 Romhilt-Estes > 4 points



 Romhilt-Estes > 5 points




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




  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: Jan 03, 2006

  • Language:

  • Users Online

  • Medical Disclaimer

    El contenido de este sitio web son solo para fines informativos y no reemplazan la consulta con un profesional médico.
  • Recent Posts

  • Categories

  • Copyright by