Revision of the Sokolow-Lyon-Rappaport and cornell voltage criteria for left ventricular hypertrophy.
BACKGROUND
Electrocardiographically-detected left ventricular hypertrophy (LVH) is a strong predictor of cardiovascular morbidity and mortality.


OBJECTIVE
To assess the performance of the Sokolow-Lyon-Rappaport (SLR) and Cornell voltage criteria in a population sample regarding the diagnosis of LVH on echocardiogram (ECHO).


METHODS
A total of 641 out of the 682 participants of the second phase of the MONICA-Vitória project were assessed using electrocardiogram and echocardiogram. A subgroup of healthy individuals (n=269) was used to generate reference values of LV mass (LVM). Sensitivities and specificities of the electrocardiographic criteria were determined by the ROC (receptor-operator characteristics) curve in relation to the diagnosis of LVH, as defined by the internal echocardiographic criterion (LVM > 48 and 46 g/m2.7 for males and females, respectively).


RESULTS
The prevalence of LVH as detected by ECHO was 23.7% in the total sample, in which 49% of the individuals were hypertensive. The Cornell criterion showed a better association with the LVM as estimated by ECHO (r= 0.37, p < 0.01) than the SLR criterion (r= 0.19) as well as a better performance in the analysis of the area under the ROC curve. The new cut-off points for the internally-defined Cornell voltage criterion (2.3 mV for males and 1.9 mV for females) showed an acceptable combination of sensitivity (22.5 and 28% for males and females, respectively), with a high specificity (95%).


CONCLUSIONS
The classic SLR and Cornell voltage criteria showed a low performance in relation to LVH as detected by the ECHO. However, this accuracy may be improved by using the Cornell voltage criteria defined in the present study.
Rodrigues
Sérgio Lamêgo
SL
Programa de Pós-Graduação em Ciências Fisiológicas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES, Brasil.
D'Angelo
Lílian
L
Pereira
Alexandre Costa
AC
Krieger
José Eduardo
JE
Mill
José Geraldo
JG
D000328:Adult; D000368:Aged; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012727:Sex Characteristics