title: Detection of left ventricular hypertrophy by the R-wave voltage in lead aVL: population-based study.
abstract: BACKGROUND
  According to hypertension guidelines, the recommended electrocardiographic (ECG) diagnostic criteria for left ventricular hypertrophy (LVH) are the Sokolow-Lyon and Cornel voltage criteria, both with general acceptance by primary care physicians. However, it was recently reported that the R-wave voltage in lead aVL (RaVL) was as good as other more complicated and time-consuming ECG criteria to detect LVH in hypertensive patients. Therefore, our aim was to investigate if the ability of the RaVL to identify echocardiographic left ventricular hypertrophy (ECHO-LVH) could be translated to the general population, a more realistic assessment of its utility in a nonreferral setting.
  
  
  METHODS
  682 participants (43.5 % males), aged between 27 and 72 years from the urban population of Vitoria, ES, Brazil, were enrolled. We investigated the association of ECHO-LVH (LV mass >51 g/Ht(2.7)) with several ECG voltage measurements: Sokolow-Lyon and Cornel criteria, S-wave voltage in lead V3 (SV3) and RaVL.
  
  
  RESULTS
  The RaVL showed the best positive correlation with LV mass indexed to Ht(2.7), superior to both Cornell and Sokolow-Lyon criteria and was not influenced by gender. Analysis of the ROC curves showed that the RaVL depicted a significant superior performance in relation to all the other measurements in the ability to detect ECHO-LVH. SV3 was not correlated with LV mass. Thus, it seems that most of Cornell's performance depends on its simplified version, that is, RaVL.
  
  
  CONCLUSIONS
  We have shown that the simple and single assessment of RaVL presented a greater diagnostic ability in detecting ECHO-LVH in the general population, signaling its value mainly as a screening tool.
authors: Department of Physiological Sciences, Federal University of Espírito Santo, Av Marechal Campos 1468, Maruipe, Vitória, ES 29042-755, Brazil. sergiolamegor@gmail.com
authors: Sérgio Lamêgo
authors: SL
authors: Rodrigues
authors: Lílian Cláudia Souza
authors: LC
authors: Angelo
authors: Marcelo Perim
authors: MP
authors: Baldo
authors: Eduardo Miranda
authors: EM
authors: Dantas
authors: Alexandre Maulaz
authors: AM
authors: Barcelos
authors: Alexandre C
authors: AC
authors: Pereira
authors: José Eduardo
authors: JE
authors: Krieger
authors: José Geraldo
authors: JG
authors: Mill
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D014463:Ultrasonography
references: Arq Bras Cardiol. 2011 Sep;97(3):225-31
references: 21845342
references: Nutrition. 1989 Sep-Oct;5(5):303-11; discussion 312-3
references: 2520314
references: Am Heart J. 2010 May;159(5):833-40
references: 20435193
references: Hypertension. 1995 Dec;26(6 Pt 1):979-83
references: 7490158
references: Eur J Epidemiol. 2008;23(4):261-71
references: 18322806
references: Lancet. 2009 Aug 15;374(9689):525-33
references: 19683638
references: Am Heart J. 1950 Nov;40(5):696-705
references: 14783065
references: JAMA. 2003 May 21;289(19):2560-72
references: 12748199
references: Radiology. 1982 Apr;143(1):29-36
references: 7063747
references: Eur J Epidemiol. 2009;24(2):101-9
references: 19190989
references: Am J Hypertens. 2005 Feb;18(2 Pt 1):191-6
references: 15752946
references: Am J Cardiol. 1986 Feb 15;57(6):450-8
references: 2936235
references: J Hum Hypertens. 2004 Mar;18(3):139-85
references: 14973512
references: J Electrocardiol. 2008 Jul-Aug;41(4):281-6
references: 18353352
references: J Electrocardiol. 2009 Nov-Dec;42(6):593-6
references: 19608195
references: Circulation. 2001 May 15;103(19):2346-51
references: 11352882
references: Semin Nucl Med. 1978 Oct;8(4):283-98
references: 112681
references: J Hypertens. 2012 May;30(5):990-6
references: 22441347
references: J Am Coll Cardiol. 1992 Nov 1;20(5):1251-60
references: 1401629
references: J Am Coll Cardiol. 1995 Oct;26(4):1022-9
references: 7560595
references: BMJ. 2007 Oct 6;335(7622):711
references: 17726091
references: J Hypertens. 2007 Jun;25(6):1105-87
references: 17563527
references: Arq Bras Cardiol. 2007 Sep;89(3):e24-79
references: 17906811
references: J Am Coll Cardiol. 1985 Sep;6(3):572-80
references: 3161926
references: J Electrocardiol. 2012 Sep;45(5):494-7
references: 22809575
references: J Hypertens. 2012 May;30(5):884-6
references: 22495132
references: Int J Cardiol. 2009 Jul 10;135(3):323-30
references: 18929416
references: Arq Bras Cardiol. 2008 Jan;90(1):46-53
references: 18317640
references: Am Heart J. 2005 Jan;149(1):181-6
references: 15660051
references: Circulation. 1978 Dec;58(6):1072-83
references: 709763
references: Am Heart J. 1949 Feb;37(2):161-86
references: 18107386
references: J Electrocardiol. 2012 Sep;45(5):498-9
references: 22789910
references: Rev Esp Cardiol. 2003 Sep;56(9):843-7
references: 14519269
references: Eur J Echocardiogr. 2008 Nov;9(6):809-15
references: 18490279
references: J Am Coll Cardiol. 1998 Feb;31(2):383-90
references: 9462583
references: J Hypertens. 2009 Aug;27(8):1697-704
references: 19424088
references: Am J Hypertens. 2010 Aug;23(8):876-81
references: 20414193