What is the Cardiac Cornell voltage product (Electrocardiogram (ECG) Cornell product)?

From the Guidelines

The Cornell product is a valuable electrocardiographic criterion for diagnosing left ventricular hypertrophy (LVH), calculated by multiplying the Cornell voltage by the QRS duration in milliseconds, with a product greater than 2,440 mm·ms considered diagnostic for LVH. This measurement is more accurate than voltage criteria alone because it accounts for both the increased QRS amplitude and the prolonged QRS duration, reflecting the time required for electrical activation to traverse the thickened ventricular wall 1. The Cornell product has improved sensitivity compared to traditional voltage criteria, particularly in women and obese patients where standard voltage criteria may be less reliable 1.

Key Considerations

• The Cornell product is particularly useful in clinical settings where accurate detection of LVH is important for risk stratification and treatment decisions in hypertensive patients.
• Proper lead placement is crucial when using the Cornell product to diagnose LVH.
• Certain conditions like bundle branch blocks can affect QRS duration independently of LVH, potentially leading to false positive results.
• The sensitivity and specificity of the Cornell product may vary depending on the patient population, with factors such as age, gender, and body habitus influencing QRS voltages 1.

Clinical Application

• The Cornell product can be used in conjunction with other diagnostic criteria to improve the accuracy of LVH diagnosis.
• Clinicians should be aware of the limitations of the Cornell product and consider other factors that may influence QRS duration and amplitude when interpreting results 1.
• The Cornell product is a useful tool for monitoring changes in left ventricular mass over time, particularly in response to treatment 1.

From the Research

Cardiac Cornell Product

The Cardiac Cornell product, also known as the Cornell voltage-duration product (CorP), is a marker of left ventricular hypertrophy (LVH) that can be measured using electrocardiography (ECG) [ 2 ].

Detection of Left Ventricular Hypertrophy

• The Cornell product is calculated by multiplying the QRS voltage by the QRS duration [ 2 ].
• A CorP value greater than 2.440 mm.ms is considered indicative of LVH [ 2 ].
• The Cornell product has been shown to be a useful method for detecting LVH in hypertensive patients [ 2 ].
• Predictors of LVH detected by the Cornell product include prior history of LVH, hypertensive retinopathy, age, grade II hypertension, and male gender [ 2 ].

Prognostic Value of the Cornell Product

• The Cornell product has been shown to be an independent predictor of cardiac events in patients with chronic heart failure [ 3 ].
• Patients with higher Cornell product values have a greater risk of cardiac events, including cardiac death and re-hospitalization for worsening heart failure [ 3 ].
• The Cornell product is also associated with LV eccentric hypertrophy and can be used to predict future cardiac events in patients with chronic heart failure [ 3 ].

Clinical Significance of the Cornell Product

• The Cornell product is a useful ECG marker that reflects not only left ventricular mass but also LV geometry and diastolic function in hypertensive patients [ 4 ].
• The Cornell product has been shown to be associated with an increased risk of sudden cardiac death [ 5 ].
• The Cornell product, in combination with other ECG LVH criteria, can be used to assess the risk of sudden cardiac death [ 5 ].