From the Guidelines
Left ventricular hypertrophy (LVH) can be diagnosed using imaging criteria, with a maximal end-diastolic wall thickness of ≥15 mm anywhere in the left ventricle, in the absence of another cause of hypertrophy in adults, as recommended by the most recent guidelines 1. The diagnosis of LVH is crucial in clinical practice, as it indicates chronic pressure or volume overload on the heart and is associated with increased cardiovascular risk.
- The criteria for diagnosing LVH include:
- Maximal end-diastolic wall thickness of ≥15 mm anywhere in the left ventricle, in the absence of another cause of hypertrophy in adults 1
- More limited hypertrophy (13-14 mm) can be diagnostic when present in family members of a patient with HCM or in conjunction with a positive genetic test 1
- For children, a body surface area adjusted z-score of ≥2 standard deviations above the mean can be used, with a threshold of z >2.5 may be appropriate to identify early HCM in asymptomatic children with no family history, whereas for children with a definitive family history or a positive genetic test, a threshold of z >2 may suffice for early diagnosis 1
- It's essential to note that echocardiography is more accurate for diagnosing LVH, measuring left ventricular mass indexed to body surface area, with values >115 g/m² in men and >95 g/m² in women indicating LVH.
- The presence of LVH is clinically significant, and its diagnosis should be made using validated criteria, without deviation from the validated formulas, as recommended by the American Heart Association 1.
- The use of ECG criteria for LVH has limited sensitivity (typically 30-60%) but good specificity (85-95%), and computer systems should use all criteria that are supported by valid evidence for identifying LVH 1. In summary, the diagnosis of LVH should be based on the most recent and highest quality evidence, using imaging criteria, and taking into account the patient's age, family history, and genetic test results, as recommended by the 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR guideline for the management of hypertrophic cardiomyopathy 1.
From the Research
Criteria for Left Ventricular Hypertrophy (LVH)
The criteria for Left Ventricular Hypertrophy (LVH) can be identified through various electrocardiographic (ECG) and echocardiographic methods. Some of the key criteria include:
- Sokolow-Lyon voltage: ≥ 3.0mV 2
- Cornell voltage product: a multifactorial criterion that allows detection of LVH in a higher proportion of subjects 3
- Cornell Product (CP) criterion: has the greatest correlation coefficient in the association with echocardiography-defined LVH 4
- Left ventricular mass indexed for Body Surface Area (LVM/BSA) or for height2.7 (LVM/height2.7) 4, 5
- Echocardiographic LVH (ECHO-LVH) defined by LVM/BSA≥125 g/m2 in male or ≥110 g/m2 in female, LVM/BSA≥115 g/m2 in male, or ≥95 g/m2 in female, and LVM/height2.7 ≥51 g/m2.7 in male or ≥47 g/m2.7 in female 4
ECG Criteria
ECG criteria for LVH diagnosis include:
- Amplitudes of Q in V3, R in V6, S in V3, T in V6, P' in V1, P in V6 6
- R and T-axis discordance, R peak time in V6, QRS duration 6
- Cornell voltage, Cornell voltage product, Sokolow-Lyon voltage, Sokolow-Lyon product, RaVL, RaVL+SV3, RV6/RV5 ratio, strain pattern, left atrial enlargement, and QT interval 2
Limitations of ECG Criteria
The sensitivity and specificity of ECG criteria for LVH diagnosis can be limited by factors such as: