𝙇𝙑𝙃 𝙤𝙣 𝙀𝘾𝙂 – 𝙏𝙬𝙤 𝘽𝙚𝙨𝙩 𝙈𝙚𝙩𝙝𝙤𝙙𝙨

Left Ventricular Hypertrophy (LVH) is a common finding in patients with long-standing hypertension, aortic stenosis, or other conditions that increase left ventricular workload. Detecting LVH on an electrocardiogram (ECG) is crucial for identifying cardiac remodeling before structural heart disease becomes advanced. Although echocardiography remains the gold standard, ECG provides a fast and cost-effective screening tool.

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What is LVH?

LVH refers to thickening of the left ventricular wall due to chronic pressure overload. On ECG, this manifests as increased QRS voltage and often secondary repolarization (strain) changes in the lateral leads.

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Main ECG Criteria for LVH

1. Sokolow–Lyon Criteria

One of the oldest and simplest ECG criteria for LVH, mainly based on precordial lead voltages.

Formula:

S in V1 + R in V5 or V6 ≥ 35 mm (3.5 mV)

(Use the larger R wave between V5 and V6)

Optional additional criterion:

R in aVL ≥ 11 mm

Key Features:

Easy and quick to apply.

Best used in young, thin patients.

May overestimate LVH in lean individuals and underestimate it in obese or elderly patients.

Does not account for gender or age differences.

2. Cornell Criteria

Developed to improve the accuracy of voltage-based LVH detection by including both limb and chest leads, with adjustments for sex.

Formula:

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

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

Key Features:

More specific than Sokolow–Lyon.

Accounts for body and gender differences.

Reliable for both limb and chest lead analysis.

Cornell Voltage–Duration Product enhances accuracy:

(R in aVL + S in V3) × QRS duration > 2440 mm·ms indicates LVH.

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Other Supportive ECG Findings

Left axis deviation

Left atrial enlargement

ST segment depression and T-wave inversion (“strain pattern”) in lateral leads

Prolonged QRS duration

These findings reinforce the suspicion of LVH but are not diagnostic by themselves.

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Clinical Significance

LVH on ECG is not just a voltage change—it is a marker of cardiac risk. Patients with ECG evidence of LVH have higher rates of arrhythmia, heart failure, and sudden cardiac death. Recognizing it early allows for timely control of hypertension and other contributing factors.

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Takeaway:

ECG remains an invaluable first step in detecting LVH. The Sokolow–Lyon criterion is simple and traditional, while the Cornell criterion offers better accuracy and clinical reliability. Confirm findings with echocardiography, and always interpret ECG voltages in the context of the patient’s body build and clinical history.

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