title: Electrocardiographic Criteria for the Diagnosis of Left Ventricular Hypertrophy.
abstract: BACKGROUND
  Current electrocardiographic (ECG) criteria for the diagnosis of left ventricular hypertrophy (LVH) have low sensitivity.
  
  
  OBJECTIVE
  The goal of this study was to test a new method to improve the diagnostic performance of the electrocardiogram.
  
  
  METHODS
  The study was divided into 2 groups, a test and a validation cohort. In the test cohort, 94 patients were analyzed, including 47 with the diagnosis of hypertensive crisis and 47 with normal blood pressure at admission. Echocardiography was used to estimate the left ventricular mass index. Area under the curve (AUC) analysis was used for comparison of single and combined leads. The McNemar test was used to assess agreement among the ECG criteria against the left ventricular mass index. The proposed ECG criteria involved measuring the amplitude of the deepest S wave (SD) in any single lead and adding it to the S wave amplitude of lead V4(SV4). Currently accepted LVH ECG criteria such as Cornell voltage and Sokolow-Lyon were used for comparison. The validation cohort consisted of 122 consecutive patients referred for an echocardiogram regardless of the admitting diagnosis.
  
  
  RESULTS
  The SDwas the most accurate single lead measurement for the diagnosis of LVH (AUC: 0.80; p < 0.001). When both cohorts were analyzed, the SD+ SV4criteria outperformed Cornell voltage with a significantly higher sensitivity (62% [95% confidence interval [CI]: 50% to 72%] vs. 35% [95% CI: 24% to 46%]). The specificities of all the criteria were ≥90%, with no significant difference among them.
  
  
  CONCLUSIONS
  The proposed criteria for the ECG diagnosis of LVH improved the sensitivity and overall accuracy of the test.
authors.affiliation: Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida.
authors.forename: Julio G
authors.initials: JG
authors.lastname: Peguero
authors.affiliation: Department of Medicine, Mount Sinai Medical Center, Miami Beach, Florida. Electronic address: saberio.lopresti@msmc.com.
authors.forename: Saberio
authors.initials: S
authors.lastname: Lo Presti
authors.affiliation: Department of Medicine, Mount Sinai Medical Center, Miami Beach, Florida.
authors.forename: Jorge
authors.initials: J
authors.lastname: Perez
authors.affiliation: Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida.
authors.forename: Omar
authors.initials: O
authors.lastname: Issa
authors.affiliation: Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Brenes
authors.affiliation: Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Tolentino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged
keywords: electrocardiogram; left ventricular hypertrophy; novel criteria