ECG criteria's for ventricular

hypertrophy

Dessert session
Dr NAIR ANISH
LEFT VENTRICULAR HYPERTROPHY

• Sokolow-Lyon index:(Am Heart J, 1949;37:161)

• S in V 1 + R in V5 or V6 > 35 mm
• R in aVL > 11 mm

• Framingham criteria (Circulation,1990; 81:815-820)

• R avl > 11mm
• R V4-6 > 25mm
• R I + S III > 25 mm
• S V1-3 > 25 mm
• S V1 or V2 + R V5 or V6 > 35 mm
LEFT VENTRICULAR HYPERTROPHY

• Cornell voltage cr\ter\a(Circulation, 1987;3:565-72)

• S in V3 + R in aVL > 28 mm (men)
• S in V3 + R in aVL > 20 mm (women)

Cornell regression equation :

• Risk of LVH = 1/(1+ e -exp)
• [exp = 4.558 - 0.092 (SV 3 + RaVL) - 0.306 TV, - 0.212 QRS - 0.278 PTFV-, - 0.559
(gender)]

• Cornell voltage duration measurement :

• QRS duration x Cornell voltage > 2,436 mm-sec
• QRS duration x sum of voltages in all leads > 1,742 mm-sec
LEFT VENTRICULAR HYPERTROPHY
Romhilt-Estes score
ECG Criteria Points

Voltage Criteria (any of):

R or S in limb leads >20 mm
S in V x or V 2 >30 mm 3
R in V 5 or V 6 >30 mm
•ST-T Abnormalities:

ST-T vector opposite to QRS without digitalis 3

ST-T vector opposite to QRS with digitalis 1

Negative terminal P mode in V x 1 mm in depth and 0.04 sec in duration 3

Left axis deviation (QRS of -30° or more) 2

QRS duration >0.09 sec 1

Delayed intrinsicoid deflection in V 5 or V 6 (>0.05 sec) 1

 Sensitivity (%) Specificity (%)

Framingham criteria
R I + S III>25 mm 10.6 100

RVL > 11 mm 11 100

RV 5-V 6>26 mm 25 98

Sokolow'-Lyon 22 100

Cornell

voltage criterion 42 96

voltage duration measurement 51 95

Romhilt-Estes score

- 4 points 55 85
> 5 points 35 95

In W 6, deepest S + tallest R >45 mm 45 93

RVL > 7.5 mm 22 96

LEFT VENTRICULAR HYPERTROPHY

• Novacode criteria
• LVMI (g/m2) = -36.4 + 0.01 R V5 + 0.2 S V1 + 0.28 S 3 + 0.182 T(neg) V6 - 0.148 T (pos) aVR
+
1.049 QRS duration

• Seigel's Total QRS voltage criteria

• Sum of QRS voltages in all leads >179 mm
• Voltage criteria x QRS duration > 17472

• Hernandez partial voltage criterion

• Sum of QRS voltages in all leads >120 mm
LEFT VENTRICULAR HYPERTROPHY

• Natural history series -2

• QRS duration <120 ms + > 1 of following
• R or S in limb leads > 20
• S VI > 30 or R V6 > 30 mm

• The Talbot criterion

• R aVL > 16 mm

The Koito and Spodick criterion

• R V6 > R V5
LVH with LBBB

• concomitant left atrial abnormality

• QRS duration > 160 ms
• SV1-2 + RV5-6 > 45 mm (sensitivity 86% and specificity 100%)

LVH with LAHB

• Max R/S in precordial leads + S3 >30 (men) / > 28 (women)

• Specificity 87% , Sensitivity 96%, PPV 89% and NPV 95%
• S V1/2 + (R +S)V5/V6 > 25
• R Avl > 13 mm
LVH with RBBB

• Max R/S precordial lead (with LAD) >29mm

• S III+max R/S precordial (with LAD) >40 mm
• S V1 >2mm
• R 1 >11 mm
• R V5/6 >15 mm
• Sokolow index > 35 mm ( Specificity 100% )
• LAE
RIGHT VENTRICULAR HYPERTROPHY
Criterion SENSITIVITY (%) Specificity (%)

Vi 6 98
R/S in V x> 1 with R >
0.5 mV
R in V 1> 0.7 mV 2 99

qR in V 1 5 99

S in V 1 <2 mm 6 98

IDT in V 1 0.35 s 8 98
RIGHT VENTRICULAR HYPERTROPHY

Criterion Sensitivity (%) Specificity (%)

V s-V 6
93

H
R/S in V 5 or V 6 < 1 16

S in V 5 or V 6 > 0.7 mV 26 90

R V 5-V 6 <5 mm 13 87
Vi + V6 RV 1 + SV 5-V 6 >10.5 mm

R in V 5 or V 6 > 0.4 mV
with S in V 1 < 0.2 mV
AQRS 110° 15 96

SI, SII, SIII

24 87
RVH IN RBBB

• Incomplete RBBB
• An rsR' complex in V 1 (R' > 10 mm), with a QRS duration of < 0.12 seconds.
• R' > r with assymetric negative T V2/3 and RAD

• Complete RBBB
• Barker and Valencia criteria : R' > 15 mm
• Milnor criteria
• Frontal QRS axis +110 to +270
• R'/S V1 > 1 ( provided R' V1 > 5 mm)
• QRS > 140 msec
• RAD
• R/S ratio in lead I is < 0.5.
Biventricular Enlargement

• Rs in V5/V6 + rSR' pattern in V± + P wave of biatrial enlargement

• Tall R wave in V5/6 with QRS axis > 90
• Diphasic RS complexes in midprecordial leads > 50 mm (Katz-Wachtel
phenomenon)
• SV-L + S V2 + R V5/ 6, + AQRS shifted to the right or S-, SM -, Sm
• QRS complexes within normal limits but with significant repolarization
abnormalities (negative T wave and depression of the ST segment),
mainly when the patient presents with atrial fibrillation