An Appraisal of the Electrocardiographic Criteria for Diagnosis of Left Ventricular Hypertrophy in Koreans: Comparison to Echocardiographic Measurement of Left Ventricular Mass

Abstract

Background and Objectives：Left ventricular hypertrophy (LVH) is associated with an increased risk of cardiovascular morbidity and mortality. Electrocardiography (ECG) is a widely available, simple and cost-effective screening method for the diagnosis of left ventricular hypertrophy. Since all the ECG criteria for LVH used for Koreans are based on ECG data from Caucasians, i.e., people whose body size is generally bigger than Koreans, its test accuracy may be low. The purpose of this study was to investigate by ECG the best cut-off value for LVH in terms of the left ventricular mass, as determined by echocardiogram. Subjects and Methods： We investigated ECG and echocardiograms of 200 consecutive patients who visited the Korean University Anam Hospital. The sensitivity, specificity and diagnostic accuracy of the left ventricular mass for LVH, by the Sokolow-Lyon voltage criteria and Romhilt-Estes point score, were calculated and compared according to the cut-off values of 35, 40 and 45 mm and 3, 4 and 5 points, respectively. Results：The sensitivities of the Sokolow-Lyon voltage criteria at 40 mm were slightly decreased (42.5, 37.5 and 8.8%；≥35, ≥40, ≥45 mm), but the specificities and diagnostic accuracies were increased (specificities of 84.2, 95.0 and 99.2%, and diagnostic accuracies of 67.5, 72.0 and 63%；≥35, ≥40, ≥45 mm). The sensitivities of a Romhilt-Estes point score of 4 points were slightly decreased (43.8, 37.5 and 13.8%；≥3, ≥4, ≥5 points), but the specificities and diagnostic accuracies were increased (specificities 85.8, 94.2 and 98/3%, and diagnostic accuracies 69.0, 71.5 and 64.5%；≥3, ≥4, ≥5 points). Conclusion：The Sokolow-Lyon voltage criteria at 40 mm or more and a Romhilt-Estes point score 4 points or more are appropriate ECG criteria for LVH in Koreans. (Korean Circulation