Circulation, Vol 75, 565-572, Copyright © 1987 by American Heart Association
PN Casale, RB Devereux, DR Alonso, E Campo and P Kligfield
In a previous study of 543 patients we developed, using echocardiographic
left ventricular mass as the reference standard, two new sets of criteria
that improve the electrocardiographic diagnosis of left ventricular
hypertrophy (LVH). One set of criteria, which is suitable for routine
clinical use, detects LVH when the sum of voltage in RaVL + SV3 (Cornell
voltage) exceeds 2.8 mV in men and 2.0 mV in women. The second set of
criteria, suitable for use in interpretation of the computerized
electrocardiogram, uses logistic regression models based on
electrocardiographic and demographic variables with independent predictive
value for LVH, with separate equations for patients in sinus rhythm and
atrial fibrillation. To test these criteria prospectively with use of a
different reference standard, antemortem electrocardiograms were compared
with left ventricular muscle mass measured at autopsy in 135 patients.
Sensitivity of standard Sokolow-Lyon voltage (SLV) criteria (SV1 + RV5 or
RV6 greater than 3.5 mV) for LVH was only 22%, but specificity was 100%.
The Cornell voltage criteria improved sensitivity to 42%, while maintaining
high specificity at 96%. Higher sensitivity (62%) was achieved by use of
the new regression criteria, with a specificity of 92%. Overall test
accuracy was 60% for SLV criteria, 68% for the Cornell voltage criteria,
and 77% for the new regression criteria (p less than .005 vs SLV). We
conclude that the Cornell voltage criteria improve the sensitivity of the
electrocardiogram for detection of LVH and are easily applicable in
clinical practice.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings
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