Araoye's Criteria is NOT a Recognized Standard Voltage Criteria for LVH
Among the listed voltage criteria for left ventricular hypertrophy (LVH), Araoye's criteria is the one that is NOT a recognized standard according to major cardiology guidelines. 1
Recognized Standard Voltage Criteria for LVH
The American Heart Association (AHA) and American College of Cardiology Foundation (ACCF) guidelines specifically mention the following established voltage criteria for LVH:
- Sokolow-Lyon criteria: Sum of S wave in V1 and R wave in V5 or V6 > 35 mm 1
- Cornell voltage criteria: Sum of S wave in V3 and R wave in aVL > 28 mm in men and > 20 mm in women 2
- Romhilt-Estes criteria (also known as "point score"): A scoring system that incorporates QRS voltage, ST-T abnormalities, left atrial involvement, and QRS axis 1
Why Araoye's Criteria is Not Standard
While Araoye's criteria has been studied in some regional populations (particularly in southwestern Nigeria), it is not mentioned in the major international cardiology guidelines as a standard criterion for LVH diagnosis 3. Unlike the other criteria listed, Araoye's criteria has limited validation in diverse populations and is not widely adopted in clinical practice outside specific regions.
Comparison of Recognized Criteria
- Sokolow-Lyon: One of the oldest and most widely used criteria, with high specificity (60-65%) but limited sensitivity (20-60%) 4, 5
- Cornell voltage: Better balanced sensitivity and specificity compared to Sokolow-Lyon, with the highest area under the ROC curve (0.678) in some studies 5
- Romhilt-Estes: Point score system with good specificity (95%) but moderate sensitivity (50%) 6
- Gubner-Ungerleider: Though less commonly used, it is still recognized in guidelines with high specificity (86.89%) but very low sensitivity (13.79%) 3
Special Considerations in LVH Diagnosis
Conduction Abnormalities
When conduction abnormalities are present, standard voltage criteria may be less reliable:
With Left Bundle Branch Block (LBBB): The diagnosis of LVH should be made with caution, using specific criteria such as SV2 + RV6 > 4.5 mV, which has shown 86% sensitivity and 100% specificity 7
With Right Bundle Branch Block (RBBB): Modified criteria are recommended, including SV1 > 2 mm, RV5/6 > 15 mm, and QRS axis to the left of 30° 1
Other Factors Affecting Voltage Criteria
- Age: QRS voltage tends to decline with increasing age 1
- Gender: Women have slightly lower upper limits of QRS voltage than men 1
- Body habitus: Obesity can mask LVH by reducing QRS voltage despite increased left ventricular mass 1
Clinical Implications
When diagnosing LVH, it's important to:
- Use multiple validated criteria rather than relying on a single criterion 1
- Consider factors that may affect accuracy (age, gender, race, body habitus) 1
- Recognize that voltage criteria alone have limitations, and consider supporting findings such as ST-T abnormalities, P-wave abnormalities, and QRS duration 2
- Understand that combining different criteria (e.g., Cornell product with Sokolow-Lyon voltage) can increase diagnostic yield to approximately 33-39% 4
The diagnosis of LVH has important prognostic implications, as the presence of LVH with ST-T abnormalities is associated with larger left ventricular mass and higher risks of cardiovascular complications and mortality than increased QRS voltage alone 1.