Sokolow-Lyon voltage criteria in sickle cell patients

The electrocardiogram remains the most commonly used method of cardiac assessment in developing countries. To determine the prevalence of electrocardiographic left ventricular hypertrophy (LVH) and the clinical significance of Sokolow-Lyon voltage criteria in sickle cell patients, echocardiographic and ECG findings were studied in 112 patients (71 with haemoglobin SS disease and 41 with haemoglobin SC disease). Electrocardiographic left ventricular hypertrophy (ECGLVH) defined as Sokolow-Lyon voltage > or = 35 mm was detected in 39 (55%) SS patients and 11 (27%) SC patients. This prevalence was higher in men than in women. There were statistically significant trends for increasing prevalence of ECGLVH with height (p < 0.007 in SS, and p < 0.01 in SC, patients) and with left ventricular internal dimension (p < 0.05 in SS, and p < 0.01 in SC, patients). But no significant trend was found with increasing posterior wall (PWT) or interventricular septal thickness (IVST). Sensitivity of Sokolow-Lyon criteria for detection of echocardiographic left ventricular hypertrophy was 63% and 33% in SS and SC patients, respectively, and specificity was 51% and 74%, respectively. Sokolow-Lyon voltage correlated with left ventricular mass in SS and SC patients (r = 0.44, p < 0.01 and r = 0.32, p < 0.05) and with left ventricular internal dimension (r = 0.2, p < 0.01 and r = 0.32, p < 0.05) but not significantly with PWT and IVST. We conclude that, in sickle cell patients, the electrocardiographic LVH mainly indicates the existence of an eccentric echocardiographic LVH with increase of left ventricular internal dimension.