title: Electrocardiographic Criteria for Left Ventricular Hypertrophy in Asians Differs from Criteria Derived from Western Populations--Community-based Data from an Asian Population.
abstract: BACKGROUND
  Electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH), such as the Cornell and Sokolow-Lyon voltage criteria were derived from Western populations. However, their utility and accuracy for diagnosing echocardiographic LVH in Asian populations is unclear. The objective of this study was to assess the accuracy of ECG criteria for LVH in Asians and to determine if alternative gender-specific ECG cut-offs may improve its diagnostic accuracy.
  
  
  METHODS
  ECG and echocardiographic assessments were performed on 668 community-dwelling Asian adults (50.9% women; 57 ± 10 years) in Singapore. The accuracy of ECG voltage criteria was compared to echocardiographic LVH criteria based on the American Society of Echocardiography guidelines, and Asian ethnicity and gender-specific partition values.
  
  
  RESULTS
  Echocardiographic LVH was present in 93 (13.6%) adults. Cornell criteria had low sensitivity (5.5%) and high specificity (98.9%) for diagnosing LVH. Modified gender specific cut-offs (18 mm in women, 22 mm in men) improved sensitivity (8.8% to 17.5%, 0% to 14.7%, respectively) whilst preserving specificity (98.2% to 94.2%, 100% to 95.8%). Similarly, Sokolow-Lyon criteria had poor sensitivity (7.7%) and high specificity (96.1%) for diagnosing LVH. Lowering the cut-off value from 35 mm to 31 mm improved the sensitivity in women from 3.5% to 14% while preserving specificity at 94.2%. A cut-off of 36 mm was optimal in men (sensitivity of 14.7%, specificity of 95.5%).
  
  
  CONCLUSIONS
  Current ECG criteria for LVH derived in Western cohorts have limited sensitivity in Asian populations. Our data suggests that ethnicity- and gender-specific ECG criteria may be needed.
authors.affiliation: The National University Heart Centre, Singapore.
authors.forename: Chang Fen
authors.initials: CF
authors.lastname: Xu
authors.forename: Eugene S J
authors.initials: ES
authors.lastname: Tan
authors.forename: Liang
authors.initials: L
authors.lastname: Feng
authors.forename: Rajalakshmi
authors.initials: R
authors.lastname: Santhanakrishnan
authors.forename: Michelle M Y
authors.initials: MM
authors.lastname: Chan
authors.forename: Shwe Zin
authors.initials: SZ
authors.lastname: Nyunt
authors.forename: Tze Pin
authors.initials: TP
authors.lastname: Ng
authors.forename: Lieng Hsi
authors.initials: LH
authors.lastname: Ling
authors.forename: A Mark
authors.initials: AM
authors.lastname: Richards
authors.forename: Carolyn S P
authors.initials: CS
authors.lastname: Lam
authors.forename: Toon Wei
authors.initials: TW
authors.lastname: Lim
mesh_terms: D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D061827:Dimensional Measurement Accuracy; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012737:Sex Factors; D012846:Singapore / Q000453:epidemiology