Abstract 17506: Cornell Criterion Detects Left Ventricular Hypertrophy Better Than Other Voltage Criteria as Age Advances

Abstract

INRODUCTION: Three of the commonly used electrocardiogram (ECG) criteria for diagnosing left ventricular hypertrophy (LVH) based on QRS voltages are the Sokolow-Lyon, Romhilt and Cornell indices. The influence of age and gender on the diagnostic accuracy of these criteria has not been extensively studied. Consequently, it is not clear whether one particular criterion should be used preferably over others to diagnose LVH in different categories of patients. We addressed this question by comparing the sensitivities of these 3 ECG-LVH indices in men and women in different age categories.

METHODS: In a cohort of 12,015 hospitalized patients in whom an echocardiogram had been performed within 7 days of the index ECG, we diagnosed LVH as being a left ventricular mass index (LVMI) greater than 115 g/m² in men and 95 g/m² in women. We identified patients with ECG-LVH by each of the 3 examined ECG indices and compared sensitivities with patients stratified by sex and 3 age categories (35 -60 years, 61 -80 years and more than 80 years). We used gender-specific Cornell criteria to diagnose LVH (LVH = R-aVL + SV3 >20 mV in women and > 28 mV in men).

RESULTS: The prevalence of echocardiogram diagnosed LVH in the population was 39%. For each criterion, chi square tests were used to analyze the difference in sensitivity between age categories (see Table). Cornell criterion detected 13.7% of LVH cases under age 60 years, 16.8% between 61 and 80 years, and 17.6% of LVH cases 80 years and older, a statistically significant trend. Sensitivity for Sokolow-Lyon was best in younger patients and decreased with age. The Romhilt criterion performed least well.

CONCLUSION: The sensitivity for detecting LVH is low by all criteria, but it was best using the gender-specific Cornell criteria, which were the only indices to demonstrate improved sensitivity as patients aged. Among these 3 ECG-LVH indices, the Cornell criteria perform best in all age groups, particularly in patients over 60 years old.