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

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: S_v1 or S_v2+R_v5≥35 mm, S_v1+R_v5 or R_v6>30 mm, S_v1, or S_v2 + R_v5 or R_v6>35 mm, S_v2+R_v4 or R_v5>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 aV_L>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%: S_v1≥24 mm, R aV_L>11 mm, R_I+S_III>25 mm, R_I>13 mm, R aV_L>12 mm, R_I>15 mm, R aV_L>13 mm, and S aV_R>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.