title: Variability and concordance of Cornell and Sokolow-Lyon electrocardiographic criteria in hypertensive patients.
abstract: OBJECTIVE
  To assess the variability and concordance of left ventricular hypertrophy electrocardiographic (LVH-ECG) criteria.
  
  
  RESULTS
  Convenience sampling of hypertensive subjects without coronary disease or bundle branch blocks. Two electrocardiograms (ECGs) were performed on each patient. Two investigators carried out two blind-readings of each ECG (Cornell and Sokolow-Lyon criteria). The between-rater and within-rater reliability were assessed (intraclass correlation coefficient, ICC). Poor concordance was defined: mean voltage difference between both ECGs >2 mm; 824 ECG readings were performed in 103 subjects (58.3% females), aged 66.8±8.8 years, mean blood pressure 141±15.10/78±9.0 mmHg. The between-rater ICCs of the baseline ECG were 0.97(95% CI 0.96-0.98) and 0.98 (95% CI 0.97-0.99) for Cornell and Sokolow-Lyon criteria, respectively. Poor concordance was found in 39.8% and in 41.7% of the cases for Cornell and Sokolow-Lyon criteria, respectively. Systolic blood pressure was found to be significant and positively associated with both criteria. Elderly hypertensive subjects, with higher ECG voltages and lower pulse pressure presented poor concordance of Cornell criteria.
  
  
  CONCLUSIONS
  The between-rater and within-rater reliability of Cornell and Sokolow-Lyon criteria is minimal. Approximately 40% of hypertensive subjects presented poor concordance in a second ECG. Older patients with lower pulse pressure and higher baseline voltages presented poorer reproducibility of LVH-ECG criteria.
authors.affiliation: La Mina Primary Care Center, University of Barcelona, CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN, Instituto de Salud Carlos III) , Barcelona, Spain. 23561evb@comb.cat
authors.forename: Ernest
authors.initials: E
authors.lastname: Vinyoles
authors.forename: Teresa
authors.initials: T
authors.lastname: Rodriguez-Blanco
authors.forename: Mariano
authors.initials: M
authors.lastname: de la Figuera
authors.forename: Josep M
authors.initials: JM
authors.lastname: Colomé
authors.forename: Marta
authors.initials: M
authors.lastname: Tafalla
authors.forename: Núria
authors.initials: N
authors.lastname: Calbet
authors.forename: M Isabel
authors.initials: MI
authors.lastname: Fernández-San Martin
authors.forename: Judit
authors.initials: J
authors.lastname: García-Alonso
authors.forename: Cristina
authors.initials: C
authors.lastname: Murillo
authors.forename: Josep
authors.initials: J
authors.lastname: Agudo
mesh_terms: D000368:Aged; D004562:Electrocardiography / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D016019:Survival Analysis; D016896:Treatment Outcome