A New Better Way to Detect LVH on ECG

Written by Thomas Davis, MD.

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Adding the magnitudes of the deepest S wave anywhere in the ECG to the deepest S wave in lead V4 (SD + SV4) was the most sensitive ECG test for LVH (62%) while maintaining specificity above 90%.

Why does this matter?
LVH is associated with increased risk for cardiac death, stroke, heart failure, and arrhythmia.  Identification of LVH and subsequent treatment with anti-hypertensives can reverse LVH and appears to reduce many of these risks.  However, among the 37 ECG criteria endorsed by the AHA to diagnose LVH, even the Cornell voltage criteria — generally considered the most accurate — has sensitivity of only 20-40%.

The Lo down on the Peguero-Lo Presti criteria for LVH
This study retrospectively evaluated a combined 216 patients in a test cohort and a validation cohort.  Using echocardiography as the reference standard, the study compared the Peguero-Lo Presti criteria (SD + SV4) to several other commonly used ECG criteria for LVH.  Using cutoffs of >/=2.3mV for females and >/=2.8mV for males, the Peguero-Lo Presti criteria had a far superior sensitivity for LVH (62%) compared to the next highest performer (Cornell voltage criteria, 35%).  One millivolt = 10 small vertical boxes, 2 large boxes. The Peguero-Lo Presti criteria maintained specificity at 90%, which was similar to the other criteria evaluated.

Source
Electrocardiographic Criteria for the Diagnosis of Left Ventricular Hypertrophy.  J Am Coll Cardiol. 2017 Apr 4;69(13):1694-1703. doi: 10.1016/j.jacc.2017.01.037.

Peer reviewed by Clay Smith, MD.

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