What are the sensitivity and specificity of the Sokolow-Lyon (Electrocardiogram criteria)?

From the Guidelines

The Sokolow-Lyon criteria for left ventricular hypertrophy (LVH) has a sensitivity of approximately 20-30% and a specificity of about 90-95%. This electrocardiographic diagnostic tool measures the amplitude of QRS complexes to identify LVH, specifically by adding the S wave in V1 and the R wave in V5 or V6 (whichever is larger), with a threshold of ≥35 mm indicating LVH. The relatively low sensitivity means that many cases of LVH may be missed when using this criteria alone, but the high specificity indicates that when the criteria is met, LVH is likely present. Some key points to consider when using the Sokolow-Lyon criteria include:

• The sensitivity varies depending on the population being studied, with factors such as age, sex, body habitus, and ethnicity affecting results 1.
• Despite its limitations in sensitivity, the Sokolow-Lyon criteria remains clinically useful due to its simplicity and high specificity, though it should be considered alongside other diagnostic methods such as echocardiography when evaluating patients for LVH.
• For optimal clinical application, remember that false negatives are common, but false positives are relatively rare. It's also important to note that the accuracy of the Sokolow-Lyon criteria can be affected by the presence of other electrocardiographic abnormalities, such as left bundle-branch block (LBBB), which can make it more difficult to diagnose LVH 2. In terms of clinical application, the Sokolow-Lyon criteria should be used in conjunction with other diagnostic tools and clinical evaluations to ensure accurate diagnosis and effective management of patients with suspected LVH.

From the Research

Sensitivity and Specificity of the Sokolow-Lyon Criteria

• The sensitivity and specificity of the Sokolow-Lyon criteria for left ventricular hypertrophy (LVH) have been evaluated in several studies 3, 4, 5, 6.
• According to a study published in 1997, the Sokolow-Lyon criteria (SV1 + RV5 or V6 > 3.5 mV) had a sensitivity of 22% and a specificity of 79% 3.
• Another study published in 2005 found that the Sokolow-Lyon voltage criteria had a sensitivity of 48% and a specificity of 80% in Nigerian hypertensives 5.
• A study published in 2012 compared the diagnostic performance of the Cornell and Sokolow-Lyon voltage criteria in Korean patients and found that the Sokolow-Lyon voltage criteria had a lower sensitivity and specificity compared to the Cornell voltage criteria 4.
• A study published in 2008 revised the Sokolow-Lyon-Rappaport and Cornell voltage criteria for LVH and found that the new cut-off points for the Cornell voltage criterion showed an acceptable combination of sensitivity (22.5 and 28% for males and females, respectively) with a high specificity (95%) 6.
• It is worth noting that the sensitivity and specificity of the Sokolow-Lyon criteria may vary depending on the population being studied and the criteria used to define LVH.

Comparison with Other Criteria

• The Sokolow-Lyon criteria have been compared with other electrocardiographic criteria for LVH, such as the Cornell voltage criteria and the Romhilt-Estes point score system 3, 4, 5.
• The Cornell voltage criteria have been found to have a better performance than the Sokolow-Lyon criteria in some studies 4, 6.
• The Romhilt-Estes point score system has been found to have a higher specificity than the Sokolow-Lyon criteria, but a lower sensitivity 3, 5.

Clinical Implications

• The Sokolow-Lyon criteria are widely used for the diagnosis of LVH, but their sensitivity and specificity may be limited in certain populations 3, 4, 5, 6.
• The use of revised cut-off points for the Cornell voltage criterion may improve the accuracy of LVH diagnosis 6.
• The choice of electrocardiographic criteria for LVH diagnosis should be based on the individual patient's characteristics and the specific clinical context.