Written by Thomas Davis, MD.
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.
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.
2 thoughts on “A New Better Way to Detect LVH on ECG”
What was the cutoff for the new formula?
Hey Max. It was 2.8mV (28 little vertical boxes) for men and 2.3mV (23 little vertical boxes) for women. S in lead V4 + any other S wave on the tracing.