title: R Wave in aVL Lead is a Robust Index of Left Ventricular Hypertrophy: A Cardiac MRI Study.
abstract: BACKGROUND
  In patients free from overt cardiac disease, R wave in aVL lead (RaVL) is strongly correlated with left ventricular mass index (LVMI) assessed by transthoracic echocardiography. The aim of the present study was to extend this finding to other settings (cardiomyopathy or conduction disorders), by comparing ECG criteria of left ventricular hypertrophy (LVH) to cardiac MRI (CMR).
  
  
  METHODS
  In 501 patients, CMR and ECG were performed within a median-period of 5 days. CMR LVH cut-offs used were 83 g/m2 in men and 67 g/m2 in women.
  
  
  RESULTS
  RaVL was independently correlated with LVMI in patients with or without myocardial infarction (MI) (N = 300 and N = 201, respectively). SV3 was independently correlated with LVMI and LV enlargement only in patients without MI. In the whole cohort, RaVL had area under receiver-operating characteristic curve of 0.729 (specificity 98.3%, sensitivity 19.6%, optimal cut-off 1.1 mV). The performance of RaVL was remarkable in women, in Caucasians, and in the presence of right bundle branch block. It decreased in case of MI. Overall, it is proposed that below 0.5 mV and above 1.0 mV, RaVL is sufficient to exclude or establish LVH. Between 0.5 and 1 mV, composite indices (Cornell voltage or product) should be used. Using this algorithm allowed classifying appropriately 85% of the patients.
  
  
  CONCLUSIONS
  Our results showed that RaVL is a good index of LVH with a univocal threshold of 1.0 mV in various clinical conditions. SV3 may be combined to RaVL in some conditions, namely LV enlargement to increase its performance.
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Génomique Fonctionnelle de l'Hypertension artérielle, Villeurbanne, France; Hôpital Nord-Ouest, Villefranche-sur-Saône, France;
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Courand
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France;
authors.forename: Adrien
authors.initials: A
authors.lastname: Grandjean
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France;
authors.forename: Paul
authors.initials: P
authors.lastname: Charles
authors.affiliation: Cardiology Department, Hôpital Nord-Ouest, Villefranche-sur-Saône, France;
authors.forename: Vinciane
authors.initials: V
authors.lastname: Paget
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France;
authors.forename: Fouad
authors.initials: F
authors.lastname: Khettab
authors.affiliation: Génomique Fonctionnelle de l'Hypertension artérielle, Villeurbanne, France; Hôpital Nord-Ouest, Villefranche-sur-Saône, France;
authors.forename: Giampiero
authors.initials: G
authors.lastname: Bricca
authors.affiliation: Radiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Boussel
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Génomique Fonctionnelle de l'Hypertension artérielle, Villeurbanne, France; Hôpital Nord-Ouest, Villefranche-sur-Saône, France;
authors.forename: Pierre
authors.initials: P
authors.lastname: Lantelme
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Génomique Fonctionnelle de l'Hypertension artérielle, Villeurbanne, France; Hôpital Nord-Ouest, Villefranche-sur-Saône, France;
authors.forename: Brahim
authors.initials: B
authors.lastname: Harbaoui
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: ECG; R wave in aVL lead.; blood pressure; cardiac MRI; hypertension; left ventricular hypertrophy