Improved performance of traditional ECG for diagnosis of left ventricular hypertrophy in hypertension

Abstract

In order to improve performance of traditional electrocardiography (ECG) for diagnosis of left ventricular hypertrophy (LVH), we developed a new index defined by a typical strain pattern or a modified Cornell voltage (R wave amplitude in aVL, plus [(half of the S wave amplitude in V3) x body mass index (BMI) (kg/m )]. ROC curve-based partition value for LVH is 420 mV●kg/m. Halving S wave in V3 and adjustment for BMI result from multivariate analyses of ECG variables for prediction of LV mass. We examined 2612 untreated subjects (age 50 12, 56% men) with essential hypertension and good quality ECG and echo tracings. Prevalence of LVH at echo (LV mass 51.0 g/height—) was 31.1%. The following ECG criteria for LVH were compared with the new index: (a) Romhilt-Estes score 5 points, (b) Sokolow-Lyon voltage; (c) Traditional Cornell voltage (S wave in V3 plus R wave in aVL 2.0 mV (women) and 2.8 mV (men); (d) Perugia score (typical strain pattern or Cornell voltage 2.0 mV (women) and 2.4 mV (men). As shown in the figure, the modified Cornell voltage resulted in a