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Potential of R Wave in aVL Lead in Cardiovascular Risk Assessment.

Juraj Jug1,2, Martina Lovrić Benčić2,3, Tomislav Bulum2,4

  • 1Family Medicine Department, Health Center Zagreb-West, 10000 Zagreb, Croatia.

Biomedicines
|May 4, 2026
PubMed
Summary
This summary is machine-generated.

R wave amplitude in the aVL ECG lead (RaVL) is a valuable marker for cardiovascular risk and target organ damage in arterial hypertension. A threshold of RaVL > 0.40 mV indicates high cardiovascular risk, comparable to the SCORE 2 model.

Keywords:
arterial hypertensionarterial stiffnesscardiovascular riskelectrocardiographyrisk factors

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Area of Science:

  • Cardiology
  • Hypertension Research
  • Electrocardiography

Background:

  • R wave amplitude in the aVL ECG lead (RaVL) is linked to cardiovascular risk, target organ damage, and mortality in arterial hypertension.
  • While RaVL > 1.1 mV suggests left ventricular hypertrophy, the precise threshold for identifying high-risk patients remains undetermined.
  • This study investigates RaVL in relation to hypertensive urgencies and compares its prognostic value with the established SCORE 2 model.

Purpose of the Study:

  • To compare RaVL values in hypertensive patients with and without hypertensive urgencies against healthy controls.
  • To identify independent predictors of elevated RaVL.
  • To evaluate the prognostic value of RaVL for cardiovascular risk stratification compared to the SCORE 2 model.

Main Methods:

  • A cross-sectional study involving 339 participants: 100 with arterial hypertension and hypertensive urgency, 134 with arterial hypertension without urgency, and 105 healthy controls.
  • Data collection included standard 12-lead ECG, ambulatory blood pressure monitoring, basic laboratory tests, SCORE 2 risk calculation, and pulse wave velocity (PWV) measurement.
  • Participants were stratified into groups based on blood pressure monitoring results.

Main Results:

  • Participants with arterial hypertension and hypertensive urgency exhibited significantly higher RaVL values (0.76 ± 0.24 mV) compared to those without urgency (0.49 ± 0.27 mV) and healthy subjects (0.22 ± 0.25 mV).
  • Elevated RaVL was more prevalent in males and non-dippers.
  • Independent predictors of RaVL included age, mean arterial pressure, PWV, and SCORE 2 risk. An RaVL threshold > 0.40 mV demonstrated high cardiovascular risk (58.16% sensitivity, 73.68% specificity) compared to SCORE 2.

Conclusions:

  • RaVL shows significant prognostic value for cardiovascular risk stratification in patients with arterial hypertension.
  • An RaVL threshold of > 0.40 mV effectively identifies high cardiovascular risk.
  • Larger studies are warranted to establish a precise high-risk threshold for RaVL to enhance cardiovascular risk estimation and target organ damage detection, particularly in patients with borderline SCORE 2 risk.