Criteria for ECG Diagnosis of Left Ventricular Hypertrophy
Criterion* | Finding | Points |
|---|---|---|
Cornell† | Men: V3 S wave + aVL R wave > 28 mm | N/A |
Women: V3 S wave + aVL R wave > 20 mm | N/A | |
Romhilt-Estes‡ (5 points = definite LVH; 4 points = probable LVH) | R or S wave ≥ 20 mm in any limb lead or S wave in V1 or V2 ≥ 30 mm or R wave in V5 or V6 ≥ 30 mm | 3 |
ST-T changes typical of LVH | — | |
| 1 | |
| 3 | |
Left atrial changes: P terminal wave in V1, amplitude ≥ 1 mm, and duration ≥ 0.04 second | 3 | |
Left axis deviation ≥− 30° | 2 | |
QRS duration ≥ 90 millisecond | 1 | |
Interval between QRS and R-wave peak in V5 or V6 ≥ 0.05 second | 1 | |
Sokolow-Lyon¶ | V1 S wave + V5 or V6 R wave ≥ 35 mm or aVL R wave ≥ 11 mm | N/A |
* Selected criteria sets in widespread use are represented; many other criteria for LVH have been described. | ||
† Casale PN, Devereux RB, Kligfield P, et al. Electrocardiographic detection of left ventricular hypertrophy: development and prospective validation of improved criteria. J Am Coll Cardiol. 1985;6(3):572-580. doi:10.1016/s0735-1097(85)80115-7 | ||
‡ Romhilt DW, Estes EH Jr. A point-score system for the ECG diagnosis of left ventricular hypertrophy. Am Heart J. 1968;75(6):752-758. doi:10.1016/0002-8703(68)90035-5 | ||
¶ SOKOLOW M, LYON TP. The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J. 1949;37(2):161-186. doi:10.1016/0002-8703(49)90562-1 | ||
ECG = electrocardiography; LVH = left ventricular hypertrophy. | ||
Hancock EW, Deal BJ, Mirvis DM, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology. Circulation. 2009;119(10):e251-e261. doi:10.1161/CIRCULATIONAHA.108.191097; Peguero JG, Lo Presti S, Perez J, Issa O, Brenes JC, Tolentino A. Electrocardiographic Criteria for the Diagnosis of Left Ventricular Hypertrophy. J Am Coll Cardiol. 2017;69(13):1694-1703. doi:10.1016/j.jacc.2017.01.037 | ||