• Vol. 44 No. 8, 274–283
  • 15 August 2015

Electrocardiographic Criteria for Left Ventricular Hypertrophy in Asians Differs from Criteria Derived from Western Populations—Community-based Data from an Asian Population



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Introduction: 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.

Materials and 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%).

Conclusion: 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.

Traditionally, the diagnosis and assessment of left ventricular hypertrophy (LVH) was made with the use of electrocardiography (ECG) and echocardiography, and more recently, with cardiac magnetic resonance (CMR) imaging. ECG remains widely used due to its convenience, low cost, widespread availability and high reproducibility. The importance of accurately detecting LVH has increased in recent years, with the recognition that LVH can be reversed with therapy, and that this can prevent or delay adverse clinical outcomes. Since the development of ECG criteria for the diagnosis of LVH a hundred years ago, numerous ECG voltage criteria for LVH have been proposed. Despite its high specificity, ECG voltage criteria for LVH has however, yielded poor sensitivity.

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