IMPROVED ELECTROCARDIOGRAPHIC DIAGNOSIS OF LEFT-VENTRICULAR HYPERTROPHY

This study was aimed at improving the performance of standard electroc ardiographic criteria of left ventricular hypertrophy (LVH) in essenti al hypertension using echocardiographic left ventricular mass as refer ence. In 923 white, untreated hypertensive subjects (mean age 51, prev alence of echocardiographic LVH 34%), sensitivity of electrocardiograp hic criteria of LVH varied between 9% and 33% and specificity was gene rally greater than or equal to 90%. The sum of S-V3 + R(aVL) (Cornell voltage) showed the closest association with echo cardiographic left v entricular mass (r = 0.48, p <0.001), and its performance was superior to that of Sokolow Lyon voltage in a receiver-operating characteristi c curve analysis. A modified partition value of the Cornell voltage wa s tested (>2.4 mV in men and >2.0 mV in women), that yielded a good co mbination between sensitivity (26% in men and 19% in women, overall 22 %) and specificity (96% in men and 95% in women, overall 95%). When LV H at electrocardiography was defined as the positivity of at least 1 o f the following 3 criteria-S-V3 + P-aVL >2.4 mV in men or >2.0 mV in w omen, a typical strain pattern, or a Romhilt-Estes point score greater than or equal to-sensitivity increased to 39% in men and 29% in women (overall 34%) and specificity decreased to 94% in men and 93% in wome n (overall 93%). Sensitivity of electrocardiography progressively incr eased from the first to the fourth quartile of left ventricular mass i n subjects with echocardiographic LVH. In conclusion, the performance of standard electro cardiography for the diagnosis of LVH in essential hypertension can be improved using a modified sex-specific partition value of the Cornell voltage (2.4 mV in men and 2.0 mV in women). The combination of 3 highly specific criteria (Cornell voltage, Romhilt-Es tes score, left ventricular strain) allows a further increase in sensi tivity without compromising specificity.