ELECTROCARDIOGRAPHY Improved sex - specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms : validation with autopsy findings PAUL

In a previous study of 543 patients we developed, using echocardiographic left ventricular mass as the reference standard, two new sets of criteria that improve the electrocardiographic diagnosis of left ventricular hypertrophy (LVH). One set of criteria, which is suitable for routine clinical use, detects LVH when the sum of voltage in RaVL + SV3 (Cornell voltage) exceeds 2.8 mV in men and 2.0 mV in women. The second set of criteria, suitable for use in interpretation of the computerized electrocardiogram, uses logistic regression models based on electrocardiographic and demographic variables with independent predictive value for LVH, with separate equations for patients in sinus rhythm and atrial fibrillation. To test these criteria prospectively with use of a different reference standard, antemortem electrocardiograms were compared with left ventricular muscle mass measured at autopsy in 135 patients. Sensitivity of standard Sokolow-Lyon voltage (SLV) criteria (SV, + RV5 or RV6 > 3.5 mV) for LVH was only 22%, but specificity was 100%. The Cornell voltage criteria improved sensitivity to 42%, while maintaining high specificity at 96%. Higher sensitivity (62%) was achieved by use of the new regression criteria, with a specificity of 92%. Overall test accuracy was 60% for SLV criteria, 68% for the Cornell voltage criteria, and 77% for the new regression criteria (p < .005 vs SLV). We conclude that the Cornell voltage criteria improve the sensitivity of the electrocardiogram for detection of LVH and are easily applicable in clinical practice. In addition, the new regression criteria, incorporating the T wave in V1, QRS duration, the magnitude of the negative P terminal force in V,, and patient sex, further improve electrocardiographic accuracy for the detection of LVH and are suitable for computer-based analysis of the electrocardiogram. Circulation 75, No. 3, 565-572,1987. RECENT EVALUATIONS of electrocardiographic (ECG) criteria for the detection of left ventricular hypertrophy (LVH) have shown that they recognize LVH poorly, with test sensitivities generally ranging from 20% to below 50%. 1 Since the electrocardiogram is widely used in clinical medicine, often as a screening test, development of more sensitive ECG criteria for early recognition of LVH is highly desirable, providing that high test specificity can be preserved. In a previous study of two independent, sequential clinical populations, we developed, using echocardiographically determined left ventricular mass as the refFrom the Departments of Medicine and Pathology, The New York Hospital-Cornell Medical Center, New York. Address for correspondence: Richard B. Devereux, M.D., Division of Cardiology, Box 222, New York Hospital-Cornell Medical Center, 525 East 68th St., New York, NY 10021. Received April 1, 1986; revision accepted Nov. 21, 1986. Vol. 75, No. 3, March 1987 erence standard, new ECG criteria for LVH with improved sensitivity coupled with high specificity.7 We previously demonstrated that the magnitude of the S wave in precordial lead V3, the R wave in aVL, the T wave in V1, QRS width, and the magnitude of negative P terminal forces in V1 have independent predictive value for the identification of LVH,7, 8and that consideration of patient sex can further improve test accuracy.7 Since ECG analyses are currently performed either by clinicians or by computerized systems with physician verification of diagnoses, we formulated new sets of ECG criteria for LVH that either possessed the simplicity requisite for clinical use or optimized the mathematical prediction ofLVH from ECG variables by use of a multiple logistic regression model suitable for microprocessor-based interpretation systems. For clinical detection of LVH we chose the simplest of the 565 by gest on July 5, 2017 http://ciajournals.org/ D ow nladed from