Electrocardiographic prediction of left ventricular geometric patterns in patients with essential hypertension

Background: The present study sought to determine the diagnostic value of electrocardiographic voltage criteria in predicting geometry patterns in patients with essential hypertension. Methods: Patients with essential hypertension (n=125) according to left ventricular mass index and relative wall thickness as determined by echocardiography were assigned in the following groups: normal geometry (N, n=50), concentric remodeling (CR, n=12), concentric hypertrophy (CH, n=28) and eccentric hypertrophy (EH, n=35). Each patient underwent 12-lead ECG followed by determination of conventional voltage criteria as well as peak to peak QRS lengths in each lead. Results: Voltage criteria such as Sokolow-Lyon, Cornell, Cornell product > 2440, DIR+D3S > 25 mm, and AVL R > 11 mm could not significantly predict and discriminate geometric patterns of LVH. However, they all were very specific (range 97-100%) and showed very high positive predictive values (range 94-100%) for detecting abnormal geometry. DI peak > 12 mm had a sensitivity 61%, specificity 67%, accuracy 63%, positive predictive value 81%, and negative predictive value 42% in predicting to differentiate CH from CR. Sum of the calculated values from the peak of the R to the nadir of the S wave in all limb leads > 60 mm had sensitivity 68%, specificity 75%, accuracy 70%, positive predictive value 86% and negative predictive value 50% in predicting to differentiate CH from CR. Conclusions: Conventional ECG voltage criteria could not significantly discriminate specific geometry patterns observed in patients with essential hypertension. (c) 2006 Elsevier Ireland Ltd. All rights reserved.