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Detection of left ventricular hypertrophy by the R-wave voltage in lead aVL: population-based study

Sérgio Lamêgo Rodrigues1, Lílian Cláudia Souza Angelo, Marcelo Perim Baldo

  • 1Department of Physiological Sciences, Federal University of Espírito Santo, Av Marechal Campos 1468, Maruipe, Vitória, ES 29042-755, Brazil. sergiolamegor@gmail.com

Clinical Research in Cardiology : Official Journal of the German Cardiac Society
|May 11, 2013
PubMed

Insights

The R-wave voltage in lead aVL (RaVL) effectively detects left ventricular hypertrophy (LVH) in the general population. This simple ECG measurement shows superior diagnostic ability compared to traditional criteria, making it a valuable screening tool.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Public Health

Background:

  • Current hypertension guidelines recommend Sokolow-Lyon and Cornell voltage criteria for electrocardiogram (ECG) diagnosis of left ventricular hypertrophy (LVH).
  • Previous research suggests the R-wave voltage in lead aVL (RaVL) may be a simpler alternative for LVH detection in hypertensive patients.
  • The utility of RaVL in the general population, beyond hypertensive cohorts, requires further investigation.

Purpose of the Study:

  • To evaluate the diagnostic capability of RaVL for identifying echocardiographic left ventricular hypertrophy (ECHO-LVH) in a general urban population.
  • To compare the performance of RaVL against established ECG criteria (Sokolow-Lyon, Cornell) and other voltage measurements (SV3).
  • To determine if RaVL can serve as a practical screening tool for LVH in non-referral settings.

Main Methods:

  • A cohort of 682 participants (43.5% male, aged 27-72) from Vitoria, ES, Brazil, was enrolled.
  • Echocardiographic left ventricular hypertrophy (ECHO-LVH) was defined as LV mass >51 g/Ht(2.7).
  • The association between ECHO-LVH and ECG voltage measurements (Sokolow-Lyon, Cornell, SV3, RaVL) was analyzed.

Main Results:

  • RaVL demonstrated the strongest positive correlation with LV mass indexed to Ht(2.7), outperforming Cornell and Sokolow-Lyon criteria.
  • Receiver operating characteristic (ROC) curve analysis confirmed RaVL's superior performance in detecting ECHO-LVH compared to all other ECG measurements.
  • The S-wave voltage in lead V3 (SV3) showed no correlation with LV mass; Cornell's performance appears largely attributable to its RaVL component.

Conclusions:

  • The simple assessment of RaVL offers superior diagnostic ability for detecting ECHO-LVH in the general population.
  • RaVL's effectiveness positions it as a valuable and simple screening tool for left ventricular hypertrophy.
  • This finding supports the potential integration of RaVL into routine ECG assessments for broader population screening.
Abstract

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