From the Guidelines
Voltage Criteria for Left Ventricular Hypertrophy (LVH)
The voltage criteria for LVH, excluding Sokolow-Lyon, Dunn's, Estes', and Cornell's criteria, include indices based on products of voltage and QRS duration and computation of QRS area 1.
Details of Voltage Criteria
- The criteria are based on measurements of QRS voltages, with amplitudes referred to in millimeters, where 10 mm equals 1 mV and 1 mm equals 0.1 mV 1.
- The sensitivity and specificity of these criteria vary, with sensitivity generally being less than 50% and specificity being around 85% to 90% 1.
- The accuracy of these criteria can be influenced by factors such as age, gender, race, and body habitus 1.
- The development and testing of adjustments of major diagnostic criteria for these factors are necessary for improved accuracy 1.
Other Considerations
- The value of the ECG in detecting LVH can be influenced by the types of heart disease, anatomic patterns of LVH, and degrees of hypertrophy present in different patient populations 1.
- The use of ST-T abnormalities typical of LVH to diagnose LVH in cases where voltage criteria are not met is a potential area of research 1.
- The utility of voltage and other criteria, such as QRS axis, left atrial abnormality, and QRS duration, in diagnosing LVH in the presence of LBBB requires further investigation 1.
From the Research
Voltage Criteria for Left Ventricular Hypertrophy (LVH)
The following voltage criteria for LVH are mentioned in the studies, excluding Sokolow-Lyon, Dunn's, Estes', and Cornell's criteria:
- Araoye code system 2
- Gubner-Ungerleider criteria 2
- Amplitude total and Amplitude total product criteria 3
- R-wave voltage in lead aVL (RaVL) 4
- QRS area criteria, including Cornell area and Sokolow area 5
Comparison of Voltage Criteria
The studies compare the performance of different voltage criteria for LVH diagnosis, including:
- Romhilt-Estes (R-E) criteria vs. voltage-based criteria (Cornell, modified Cornell, and Sokolow-Lyon) 6
- RaVL vs. Cornell and Sokolow-Lyon criteria 4
- ECG voltage criteria (including Cornell Voltage, Sokolov, Gubner, and Amplitude total and Amplitude total product) in patients with hypertrophic cardiomyopathy 3
- Araoye code system, Cornell, and Gubner-Ungerleider criteria vs. echocardiography 2
- Cornell and Sokolow-Lyon products, and Cornell and Sokolow-Lyon areas vs. voltage criteria 5
Performance of Voltage Criteria
The studies report the following performance of voltage criteria for LVH diagnosis:
- Araoye code system, Cornell, and Sokolow-Lyon criteria compared favorably with echocardiography 2
- Gubner-Ungerleider criterion had low sensitivity but high specificity 2
- RaVL showed the best positive correlation with LV mass indexed to Ht(2.7) and superior performance in detecting ECHO-LVH 4
- Amplitude total and Amplitude total product criteria achieved maximal diagnostic accuracy in HCM population 3
- Cornell and Sokolow-Lyon products, and Cornell and Sokolow-Lyon areas improved the detection of ECG-LVH in the hypertensive population 5