title: R wave in aVL lead: an outstanding ECG index in hypertension.
abstract: OBJECTIVE
  The voltage of R wave in lead aVL (RaVL) seems to be more tightly correlated with left ventricular mass and cardiovascular events than any other ECG criterium of left ventricular hypertrophy. We hypothesized that RaVL could be an independent predictor of all-cause and cardiovascular death in hypertensive individuals.
  
  
  METHODS
  The baseline clinical and biological variables as well as ECG recordings were analyzed in a prospective cohort of 589 hypertensive individuals.
  
  
  RESULTS
  After 10 years of follow-up, we observed 95 deaths of which 53 had a cardiovascular cause. The optimal RaVL voltages to predict all-cause and cardiovascular mortality were 0.8 and 0.6  mV, respectively. In a multivariate adjusted Cox model, having an RaVL voltage superior to these cutoffs was associated with increased risks of all-cause death [hazard ratio: 2.04, 95% confidence interval (CI): (1.30-3.22)] and of cardiovascular death [hazard ratio: 2.89, 95% CI: (1.47-5.68)]. In the whole cohort and with the same adjusted Cox regression model, each 0.1  mV increment would increase the risk of all-cause death by 1.07 times [95% CI: (1.02-1.12)] and that of cardiovascular death by 1.13 times [95% CI: (1.06-1.20)]. After excluding in turn patients with positive Sokolow index, Cornell voltage, or Cornell product, the results remained statistically significant, meaning that RaVL was still able to pick-up high-risk patients when other classical and more sophisticated indices were not observable.
  
  
  CONCLUSIONS
  The present results strengthen previous reports that demonstrated a strong role of RaVL voltage in risk stratification in hypertension.
authors.affiliation: aCardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon bGénomique Fonctionnelle de l'Hypertension artérielle, Université Claude Bernard Lyon1, Villeurbanne cHôpital Nord-Ouest, Villefranche-sur-Saône, France *Pierre-Yves Courand and Sophie Jenck contributed equally to the writing of this article.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Courand
authors.forename: Sophie
authors.initials: S
authors.lastname: Jenck
authors.forename: Giampiero
authors.initials: G
authors.lastname: Bricca
authors.forename: Hugues
authors.initials: H
authors.lastname: Milon
authors.forename: Pierre
authors.initials: P
authors.lastname: Lantelme
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D004562:Electrocardiography / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015588:Observer Variation; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome