Detection of left ventricular hypertrophy by different electrocardiographic criteria in clinical practice. Findings from the Sara study

Alberto Calderón, Vivencio Barrios, Carlos Escobar, Elena Ferrer, Sara Barrios, Victoria González-Pedel, Paloma Montoro, Josefa Navarro-Cid
Clinical and Experimental Hypertension: CHE 2010, 32 (3): 145-53
The objective of this study is to compare the validity of different product duration-based electrocardiographic criteria with the classical voltage criteria and to estimate the prevalence of left ventricular hypertrophy (LVH) for each criterion. Electro cardiographic criteria from 248 hypertensive patients attended in daily clinical practice were examined. Cornell and Sokolow-Lyon voltage indexes, Cornell and Sokolow-Lyon products, and Cornell and Sokolow-Lyon areas were determined. The presence of echocardiographic LVH was documented from the patients' clinical records. The proportion of patients with LVH detected by Cornell product was 27.3% vs. 12.9% by Cornell voltage, and 23.6% by Sokolow-Lyon product vs. 12.0% by Sokolow voltage. Both were p < 0.05. When QRS area criteria were applied, ECG-LVH was present in 32.7% (Cornell area) and 29.5% (Sokolow area) of the patients, respectively. When the composite of several criteria was applied, the detection of LVH with the combination of the Cornell product and the Sokolow-Lyon voltage index increased to 33% and with the combination of Cornell and Sokolow-Lyon products reached 39.3%. Globally, the patients diagnosed by voltage criteria were older, had higher systolic blood pressure (SBP) and a longer history of hypertension when compared to subjects diagnosed by product or area-based criteria. The Cornell and Sokolow-Lyon product and the QRS area-based criteria improve the detection of ECG-LVH in the hypertensive population. The composite of different criteria may be a useful strategy to further increase the diagnostic ability of ECG. The combinations of the Cornell product with the Sokolow voltage or with the Sokolow product appear to be the most efficient options.

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