From the Guidelines
Left ventricular hypertrophy (LVH) is diagnosed by imaging, typically with 2D echocardiography or cardiovascular magnetic resonance (CMR), showing a maximal end-diastolic wall thickness of ≥15 mm anywhere in the left ventricle in adults, as stated in the 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR guideline 1. The criteria for LVH vary between adults and children, with adults requiring a maximal end-diastolic wall thickness of ≥15 mm, while children require a body surface area-adjusted z-score of ≥2 standard deviations above the mean, with proposed thresholds of z-score >2.5 for asymptomatic children with no family history and z-score >2 for children with a definitive family history or positive genetic test 1. Key points to consider when diagnosing LVH include:
- The absence of another cardiac, systemic, or metabolic disease capable of producing the magnitude of hypertrophy evident in a given patient 1
- The presence of a disease-causing sarcomere (or sarcomere-related) variant or unresolved genetic etiology 1
- The use of imaging modalities such as 2D echocardiography or CMR to measure left ventricular wall thickness 1
- The consideration of family history and genetic testing in the diagnosis of LVH, particularly in children 1 It is essential to accurately diagnose LVH, as it is associated with increased cardiovascular risk and indicates chronic pressure overload on the heart, commonly from hypertension, aortic stenosis, or hypertrophic cardiomyopathy 1.
From the Research
Criteria for Left Ventricular Hypertrophy (LVH)
The criteria for Left Ventricular Hypertrophy (LVH) can be evaluated through various electrocardiographic (ECG) criteria, including:
- Sokolow-Lyon voltage and product
- Cornell voltage and product
- Romhilt-Estes score
- Perugia score
- Glasgow Royal Infirmary modified Romhilt-Estes score
- Peguero-Lo Presti criteria 2, 3, 4
Electrocardiographic Criteria Performance
The performance of these ECG criteria in diagnosing LVH varies, with:
- Sensitivity ranging from 7.6% to 40.9% in patients without complete left bundle branch block (CLBBB) 5
- Sensitivity ranging from 11.9% to 95.2% in patients with CLBBB 5
- The Peguero-Lo Presti criteria showing the best sensitivity and accuracy in some studies 2, 4
- The Sokolow-Lyon criteria showing high specificity in all analyses 2
Comparison of Criteria
Comparing the different criteria, studies have found that:
- Composite ECG criteria are more strongly predictive of cardiovascular mortality than voltage-only criteria 6
- Point-scoring systems, such as the Romhilt-Estes and Perugia scores, are more accurate than voltage-only criteria 3
- The Peguero ECG-LVH criteria are predictive of increased risk of death, similar to traditional ECG-LVH criteria 4
Limitations and Recommendations
The electrocardiographic criteria for LVH have limitations, including:
- Low sensitivity and specificity in some cases 5, 2, 3
- The need for further evaluation and confirmation of LVH diagnosis using echocardiography or other imaging modalities 2
- The recommendation to use these criteria to confirm the diagnosis of LVH, especially in low-complexity services that do not have image-based diagnostic tests 2