Electrocardiographic Diagnosis of Left Ventricular Hypertrophy (LVH)

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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

Related Criteria

Common Diagnostic Criteria for Left and Right Atrial Abnormalities

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References:

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]
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]
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]