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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

More...

 

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]

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Created: January 03, 2006
Last Modified: 10/17/2010

 
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