Related Experiment Video

Updated: Jan 16, 2026

Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
07:11

Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography

Published on: October 28, 2020

3.3K

Electrocardiographic LVH criteria: Poor diagnostic accuracy even with optimized cutoffs. Insights from MESA study

José Nunes de Alencar1, Sandro Pinelli Felicioni2

  • 1Electrocardiography Unit, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil; Research Division, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.

Journal of Electrocardiology
|September 30, 2025
PubMed

Insights

Electrocardiogram (ECG) voltage criteria show poor accuracy for diagnosing left ventricular hypertrophy (LVH) when compared to cardiac magnetic resonance (CMR). Combining ECG measures does not improve diagnostic performance for LVH.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Diagnostic Performance Evaluation

Background:

  • Electrocardiogram (ECG) criteria for left ventricular hypertrophy (LVH) are commonly used to estimate increased left ventricular (LV) mass.
  • However, these ECG criteria demonstrate limited sensitivity in accurately diagnosing LVH.

Purpose of the Study:

  • To evaluate the diagnostic performance of various ECG voltage criteria for LVH against cardiac magnetic resonance (CMR) in a large population cohort.
  • To assess whether combining ECG indices improves LVH detection compared to individual criteria.

Main Methods:

  • Analysis of 4849 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with ECGs and CMR-derived LV mass.
  • LVH defined by LV mass indexed to body surface area (LVMi) using established thresholds for men and women.
  • Assessment of multiple ECG criteria (Sokolow-Lyon, Cornell voltage, etc.) and combinations using logistic regression.

Main Results:

  • LVH prevalence was 30.2%.
  • ECG criteria at classic thresholds showed very low sensitivity (3.7-15.2%) but high specificity (>94%).
  • Optimized thresholds improved sensitivity (48.9-64.8%) but reduced specificity (54.4-74.3%), with modest diagnostic utility (LR+ <4).
  • Combining ECG indices did not improve diagnostic discrimination compared to the best single measure (AUC 0.646).

Conclusions:

  • ECG voltage criteria exhibit poor diagnostic performance for CMR-defined LVH, regardless of threshold optimization.
  • Aggregating multiple ECG indices does not materially enhance diagnostic accuracy for LVH.
  • Findings suggest reframing ECG voltage criteria as an electrical phenotype with prognostic value rather than a reliable diagnostic surrogate for structural hypertrophy.
Abstract

Keywords:
Diagnostic accuracyECGLVHMESAVoltage criteria

More Related Videos

Evaluation of Left Ventricular Structure and Function using 3D Echocardiography06:34

Evaluation of Left Ventricular Structure and Function using 3D Echocardiography

Published on: October 28, 2020

4.6K
Histological Quantification of Chronic Myocardial Infarct in Rats09:45

Histological Quantification of Chronic Myocardial Infarct in Rats

Published on: December 11, 2016

15.3K

Related Concept Videos

Cardiomyopathy III: Hypertrophic Cardiomyopathy01:29

Cardiomyopathy III: Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
411
Mitral Stenosis II: Clinical features and Diagnostic Tests01:23

Mitral Stenosis II: Clinical features and Diagnostic Tests

Mitral stenosis is a heart condition in which the mitral valve, which allows blood to flow from the left atrium to the left ventricle, becomes narrowed or stenotic. This narrowing hinders blood flow and leads to clinical symptoms requiring specific medical evaluations and management strategies. The following overview outlines the clinical symptoms, assessments, diagnostic findings, prevention methods, and treatments for mitral stenosis.Clinical ManifestationsDyspnea (shortness of breath): This...
220
Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

Aortic Regurgitation II: Clinical Features and Diagnostic Tests

Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
412
Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
215
Electrocardiogram01:29

Electrocardiogram

An electrocardiogram (ECG or EKG) is a critical diagnostic tool that records the electrical signals produced by the heart during each heartbeat. This recording is achieved through electrodes placed strategically on the arms, legs, and chest. The electrocardiograph amplifies these signals and produces 12 distinct tracings, offering a comprehensive understanding of the heart's electrical activity.
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
5.4K