Korean Circ J.  2012 Sep;42(9):606-613. 10.4070/kcj.2012.42.9.606.

A Comparison of Cornell and Sokolow-Lyon Electrocardiographic Criteria for Left Ventricular Hypertrophy in Korean Patients

• Park JK
• Shin JH
• Kim SH
• Lim YH
• Kim KS
• Kim SG
• Kim JH
• Lim HG
• Shin J

• KMID: 2297891
• DOI: http://doi.org/10.4070/kcj.2012.42.9.606

Abstract

BACKGROUND AND OBJECTIVES
Electrocardiography (ECG) is a cost-effective and useful method for diagnosing left ventricular hypertrophy (LVH) in a large-scale study or in clinical practice. Among ECG criteria, the Cornell product (Cor P) and Sokolow-Lyon criteria were adopted by the European Society of Hypertension-European Society of Cardiology Guidelines but have different performances among races. The aim of this study was to compare the diagnostic performance of two voltage criteria in Korean patients.
SUBJECTS AND METHODS
Electrocardiography and echocardiographic LV mass of 332 (159 male, 173 female) consecutive patients were analyzed. Cornell voltage criteria and the Cor P were compared with Sokolow-Lyon voltage (Sok V) and the Sokolow-Lyon product (Sok P). The sensitivities and specificities were estimated using a receiver-operating characteristics (ROC) curve in relation to the LVH diagnosis. The sensitivities and revised cut-off values were derived at specificity levels of 90, 95, and 100%.
RESULTS
The Cornell-based criteria generally showed better performance than that of the Sok V criteria and Sok P in the area under the ROC curve analysis. The revised cut-off values for the Cornell voltage criteria (20 and 16 mm for males and females, respectively) showed an improved sensitivity (19.7 and 30.3% for males and females, respectively), with a high specificity of 95%.
CONCLUSION
The Cornell-based criteria had better performance than that of the Sokolow-Lyon criteria in both Korean men and women. However, revised cut-off values are needed to improve accuracy.

Keyword

Electrocardiography; Echocardiography; Hypertrophy, left ventricular; Sensitivity and specificity

MeSH Terms

Cardiology
Continental Population Groups
Echocardiography
Electrocardiography
Female
Humans
Hypertrophy, Left Ventricular
Male
ROC Curve
Sensitivity and Specificity

Figure

• 

  Fig. 1 Receiver operating characteristic (ROC) curve with four electrocardiogram criteria for detecting left ventricular hypertrophy (LVH). A: the ROC curve for defining LVH using left ventricular mass (LVM)/body surface area (BSA) ≥116 g/m2 in males. B: LVM/BSA ≥96 g/m2 in females. C: LVM/height2.7 ≥49 g/m2.7 in males. D: LVM/height2.7 ≥45 g/m2.7 in females. *p<0.05, †p<0.01. blue: Sok V, brown: Sok P, orange: Cor V and green: Cor P. Sok V: Sokolow-Lyon voltage, Cor V: Cornell voltage, Sok P: Sokolow-Lyon product, Cor P: Cornell product, CI: confidence interval, AUC: area under the curves.

Reference

1. Bluemke DA, Kronmal RA, Lima JA, et al. The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (Multi-Ethnic Study of Atherosclerosis) Study. J Am Coll Cardiol. 2008. 52:2148–2155.

2. Sundström J, Lind L, Arnlöv J, Zethelius B, Andrén B, Lithell HO, et al. Echocardiographic and electrocardiographic diagnoses of left ventricular hypertrophy predict mortality independently of each other in a population of elderly men. Circulation. 2001. 103:2346–2351.

3. 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. J Am Coll Cardiol. 2009. 53:992–1002.

4. Molloy TJ, Okin PM, Devereux RB, Kligfield P. Electrocardiographic detection of left ventricular hypertrophy by the simple QRS voltage-duration product. J Am Coll Cardiol. 1992. 20:1180–1186.

5. Truong QA, Ptaszek LM, Charipar EM, et al. Performance of electrocardiographic criteria for left ventricular hypertrophy as compared with cardiac computed tomography: from the Rule Out Myocardial Infarction Using Computer Assisted Tomography Trial. J Hypertens. 2010. 28:1959–1967.

6. Rodrigues SL, D'Angelo L, Pereira AC, Krieger JE, Mill JG. Revision of the Sokolow-Lyon-Rappaport and cornell voltage criteria for left ventricular hypertrophy. Arq Bras Cardiol. 2008. 90:46–53.

7. Dahlöf B, Devereux RB, Kjeldsen SE, et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet. 2002. 359:995–1003.

8. Okin PM, Devereux RB, Jern S, et al. Regression of electrocardiographic left ventricular hypertrophy by losartan versus atenolol: the Losartan Intervention for Endpoint reduction in Hypertension (LIFE) Study. Circulation. 2003. 108:684–690.

9. Mancia G, De Backer G, Dominiczak A, et al. 2007 guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007. 25:1105–1187.

10. Okin PM, Wright JT, Nieminen MS, et al. Ethnic differences in electrocardiographic criteria for left ventricular hypertrophy: the LIFE Study. Losartan Intervention For Endpoint. Am J Hypertens. 2002. 15:663–671.

11. Sokolow M, Lyon TP. The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J. 1949. 37:161–186.

12. Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P. Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings. Circulation. 1987. 75:565–572.

13. Alfakih K, Walters K, Jones T, Ridgway J, Hall AS, Sivananthan M. New gender-specific partition values for ECG criteria of left ventricular hypertrophy: recalibration against cardiac MRI. Hypertension. 2004. 44:175–179.

14. Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation. 1978. 58:1072–1083.

15. Devereux RB, Alonso DR, Lutas EM, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986. 57:450–458.

16. De Simone G, Kizer JR, Chinali M, et al. Normalization for body size and population-attributable risk of left ventricular hypertrophy: the Strong Heart Study. Am J Hypertens. 2005. 18(2 Pt 1):191–196.

17. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005. 18:1440–1463.

18. Hotelling H. The selection of variates for use in prediction with some comments on the general problem of nuisance parameters. Ann Math Statist. 1940. 11:271–283.

19. Pewsner D, Jüni P, Egger M, Battaglia M, Sundström J, Bachmann LM. Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review. BMJ. 2007. 335:711.

20. Pewsner D, Battaglia M, Minder C, Marx A, Bucher HC, Egger M. Ruling a diagnosis in or out with "SpPIn" and "SnNOut": a note of caution. BMJ. 2004. 329:209–213.

21. Lee YW. Electrocardiographic diagnosis of left ventricular hypertrophy by scoring system. Korean Circ J. 1977. 7:1–8.

22. Xie L, Wang Z. Correlation between echocardiographic left ventricular mass index and electrocardiographic variables used in left ventricular hypertrophy criteria in Chinese hypertensive patients. Hellenic J Cardiol. 2010. 51:391–401.

23. Noble LM, Humphrey SB, Monaghan GB. Left ventricular hypertrophy in left bundle branch block. J Electrocardiol. 1984. 17:157–160.

24. Okin PM, Devereux RB, Jern S, Kjeldsen SE, Julius S, Dahlöf B. The Life Study Investigators. Baseline characteristics in relation to electrocardiographic left ventricular hypertrophy in hypertensive patients: the Losartan Intervention for Endpoint Reduction (LIFE) in Hypertension Study. Hypertension. 2000. 36:766–773.

25. Barrios V, Escobar C, Calderón A, et al. Gender differences in the diagnosis and treatment of left ventricular hypertrophy detected by different electrocardiographic criteria: findings from the SARA Study. Heart Vessels. 2010. 25:51–56.

26. Hense HW, Gneiting B, Muscholl M, et al. The associations of body size and body composition with left ventricular mass: impacts for indexation in adults. J Am Coll Cardiol. 1998. 32:451–457.

27. Schillaci G, Verdecchia P, Borgioni C, et al. Improved electrocardiographic diagnosis of left ventricular hypertrophy. Am J Cardiol. 1994. 74:714–719.

28. Devereux RB, Casale PN, Eisenberg RR, Miller DH, Kligfield P. Electrocardiographic detection of left ventricular hypertrophy using echocardiographic determination of left ventricular mass as the reference st-andard. Comparison of standard criteria, computer diagnosis and physician interpretation. J Am Coll Cardiol. 1984. 3:82–87.

29. 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. 6:572–580.

30. Verdecchia P, Dovellini EV, Gorini M, et al. Comparison of electrocardiographic criteria for diagnosis of left ventricular hypertrophy in hypertension: the MAVI Study. Ital Heart J. 2000. 1:207–215.