A Critical Appraisal of the Electrocardiographic Criteria for the Diagnosis of Left Ventricular Hypertrophy

Abstract

Thirty-three different electrocardiographic criteria for left ventricular hypertrophy have been evaluated in 360 autopsied hearts utilizing a chamber dissection technic. One hundred and sixty hearts had left ventricular hypertrophy, and 200 hearts did not (146 of these were normal, and 54 had right ventricular hypertrophy).The following five electrocardiographic criteria had a sensitivity of 56% but 10.5% to 14.5% false positives: Svi or Sv2 +RV5 '-35 mm, SV +±Rv5 or RV6 > 30 mm, Sv, or SV2 + Rv5 or RV6 > 35 mm, SV2 + RV4 or Rv5 > 35 mm, R + S > 40 mm. A point-score system employing a combination of criteria had a sensitivity of 54%, but lowered the false positives to 3%. The best limb-lead criterion was R aVL > 7.5 which had a sensitivity of 22.5% with only 3.5% false positives. The following criteria had no false positives, but the highest sensitivity was 19%: Svl, 24 mm, R aVL> 11 mm, RI + SI,, > 25 mm, RI > 13 mm, R aVL > 12 mm, RI > 15 mm, R aVL > 13 mm, and S aVR > 14 mm. Overall the precordial lead criteria were considerably more sensitive but less specific than the limb lead criteria. Since only six of the 200 hearts without left ventricular hypertrophy were in persons less than 30 years of age, this is not the major explanation for the high incidence of false positives in the more sensitive voltage criteria. The problems of using voltage criteria alone and the need for new criteria and approaches to the electrocardiographic diagnosis of left ventricular hypertrophy are discussed.

Hypertension, end-stage renal disease and mesangiocapillary glomerulonephritis in methamphetamine users

“…Left ventricular hypertrophy (LVH) was defined by Sokolow-Lyon criteria of >35 mm. [19] Renal biopsy was performed in patients with impaired renal function of unknown cause and/or proteinuria >3 g/d in the presence of normal-sized kidneys. Malignant hypertension on histology was defined as the presence of fibrinoid necrosis and onion-skinning of the arterioles associated with crenation of the glomerular basement membrane.…”

Long-Term Comparison of Apical Versus Asymmetric Hypertrophic Cardiomyopathy

“…14) Left ventricular strain was defined as an ST-T segment vector shifted in the direction opposite to the mean QRS complex. 15) A giant negative T wave was defined as a negative T wave with a depth ≥ 1 mV in V4 to V6.…”

AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram

“…The ECG criteria for LVH shown in Table 1 have evolved over the years. [65][66][67][68][69][70][71][72][73][74][75][76][77][78] Criteria were originally based on R and S amplitudes in standard limb leads I and III, using clinical and autopsy data as reference standards. 4 -6 (Amplitudes of ECG complexes are referred to in millimeters, rather than millivolts.…”