Sensitivity and specificity of electrocardiographic evaluation of LVH in 364 unselected autopsy cases a criterion, R V6 ⪰ 18 mm., is proposed

Abstract

Autopsy data and electrocardiographic findings in 364 unselected cases were studied; 163 cases were classified as having LVH on the basis of heart weight and ventricular wall thickness; 145 patients were classified into a control group, and 56 patients into an intermediate group. The mean age of the 364 patients was 68.5 years. This study compares the commonly used voltage criteria for LVH and evaluates them on the basis of sensitivity, specificity, and predictive values of a positive or negative finding. Not a single previous voltage or intrinsicoid deflection criterion had a sensitivity greater than 20 per cent of the 163 cases with LVH. The criterion with the greatest sensitivity was that of the authors' where “R” in V 6 ⪰ 18 mm. deflection. This criterion had a sensitivity of 24.6 per cent and a specificity of 93.1 per cent. When all the commonly used voltage criteria were combined with the authors' criterion, the diagnosis of LVH could be made in 46.5 per cent of the cases with a specificity of 89.6 per cent, a predictive value of a positive finding of 82 per cent and a predictive value of a negative finding of 62.3 per cent. We feel that R V6 ⪰ 18 mm. should be used with other criteria in order to increase the sensitivity and maintain specificity in making the diagnosis of LVH in the age group studied.