Related Experiment Video
Updated: Aug 20, 2025
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Diagnostic utility of 31 ECG criteria for predicting echocardiographic left ventricular geometry
Fernando De-la-Garza-Salazar1,2,3
1Department of Specialties Medical, School of Medicine, Universidad de Monterrey.
Insights
The Cornell and modified Cornell electrocardiogram (ECG) criteria show the best accuracy in identifying left ventricular geometry, outperforming other methods for detecting concentric hypertrophy and eccentric hypertrophy.
Area of Science:
- Cardiology
- Medical Diagnostics
- Biomedical Engineering
Background:
- Left ventricular (LV) geometry is crucial for cardiovascular health.
- Accurate non-invasive detection of LV geometry is essential for timely diagnosis and management.
- Electrocardiogram (ECG) criteria are widely used but their diagnostic utility for specific LV geometries requires further validation.
Purpose of the Study:
- To evaluate the diagnostic performance of 31 electrocardiogram (ECG) criteria in detecting echocardiographic (Echo) left ventricular (LV) geometries.
- To compare the accuracy, sensitivity, specificity, and predictive values of various ECG criteria.
- To identify the most effective ECG criteria for differentiating normal LV geometry from remodeling and hypertrophy.
Main Methods:
- A cross-sectional study involving 672 adults classified by Echo LV geometry: normal (NL), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH).
- Calculation and comparison of 31 state-of-the-art ECG criteria for LV hypertrophy.
- Analysis of diagnostic utility using AUC, accuracy, sensitivity, specificity, and predictive values.
- Multivariable linear regression models to assess the influence of clinical factors on ECG criteria.
Main Results:
- Cornell (ECG21) and modified Cornell (ECG31) criteria demonstrated the highest AUC for differentiating NL vs. CH, NL vs. EH, CR vs. CH, and CR vs. EH.
- These criteria showed superior performance in predicting most LV geometries compared to other evaluated ECG methods.
- Multivariable analysis indicated that CH and EH had a stronger impact on Cornell and modified Cornell voltages than BMI, age, diabetes, hypertension, or chronic heart disease.
Conclusions:
- Cornell and modified Cornell ECG criteria are the most effective for diagnosing various left ventricular geometries, particularly hypertrophy.
- These ECG criteria offer superior diagnostic utility compared to other evaluated methods for specific LV geometry classifications.
- While effective for hypertrophy, ECG criteria showed limited ability to differentiate normal LV geometry from remodeling (NL vs. CR) and concentric from eccentric hypertrophy (CH vs. EH).
Objective:
To explore the diagnostic utility of 31 electrocardiogram (ECG) criteria for detecting echocardiographic (Echo) left ventricular geometry using accuracy.
Methods:
This cross-sectional study included consecutive adults (> 18 years) that were classified by Echo left ventricular geometry as normal (NL), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). Thirty-one state-of-the-art ECG criteria for Echo left ventricular hypertrophy were calculated. AUC 95%CI, accuracy, sensitivity, specificity, and positive and negative predictive value for detecting Echo left ventricular geometries were compared. Multivariable linear regression models were produced using the ECG criteria as the dependent variable.
Results:
A total of 672 adults were included in the study. From 31 ECG criteria, Cornell (ECG21, SV3 + RaVL) and modified Cornell (ECG 31, RaVL + deepest S in all leads) criteria have the best overall AUC in differentiating NL versus CH (0.666 and 0.646), NL versus EH (0.686 and 0.656), CR versus CH (0.687 and 0.661), and CR versus EH (0.718 and 0.676). In multivariable linear regression models, CH and EH had the strongest effect on the final voltage in Cor- nell (ECG21) and modified Cornell (ECG31).
Conclusions:
From 31 state-of-the-art criteria, Cornell and modified Cornell criteria have the best AUC and accuracy for predicting most left ventricular geometries. CH and EH had the strongest effect on the voltage of Cornell and modified Cornell criteria compared to body mass index, age, diabetes, hypertension, and chronic heart disease. The ECG criteria poorly differentiate NL from CR and CH from EH.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
01:30Dysrhythmias V: Evaluating Dysrhythmias
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests