Revision of the Sokolow-Lyon-Rappaport and cornell voltage criteria for left ventricular hypertrophy.

BACKGROUND

Electrocardiographically-detected left ventricular hypertrophy (LVH) is a strong predictor of cardiovascular morbidity and mortality.

OBJECTIVE

To assess the performance of the Sokolow-Lyon-Rappaport (SLR) and Cornell voltage criteria in a population sample regarding the diagnosis of LVH on echocardiogram (ECHO).

METHODS

A total of 641 out of the 682 participants of the second phase of the MONICA-Vitória project were assessed using electrocardiogram and echocardiogram. A subgroup of healthy individuals (n=269) was used to generate reference values of LV mass (LVM). Sensitivities and specificities of the electrocardiographic criteria were determined by the ROC (receptor-operator characteristics) curve in relation to the diagnosis of LVH, as defined by the internal echocardiographic criterion (LVM > 48 and 46 g/m2.7 for males and females, respectively).

RESULTS

The prevalence of LVH as detected by ECHO was 23.7% in the total sample, in which 49% of the individuals were hypertensive. The Cornell criterion showed a better association with the LVM as estimated by ECHO (r= 0.37, p < 0.01) than the SLR criterion (r= 0.19) as well as a better performance in the analysis of the area under the ROC curve. The new cut-off points for the internally-defined Cornell voltage criterion (2.3 mV for males and 1.9 mV for females) showed an acceptable combination of sensitivity (22.5 and 28% for males and females, respectively), with a high specificity (95%).

CONCLUSION

The classic SLR and Cornell voltage criteria showed a low performance in relation to LVH as detected by the ECHO. However, this accuracy may be improved by using the Cornell voltage criteria defined in the present study.