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ECG Criteria for Left Ventricular Hypertrophy in Hypertensive Black Africans: Insights from the coArtHA Trial

Annina S Vischer1,2, Valeriya Nemtsova1, Blaise Lukau3

  • 1Medical Outpatient Department and Hypertension Centre, ESH Hypertension Centre of Excellence, University Hospital Basel, Basel, Switzerland.

Global Heart
|July 25, 2026
PubMed

Insights

Electrocardiogram (ECG) criteria for left ventricular hypertrophy (LVH) showed moderate accuracy in Black African adults with hypertension. Cornell voltage product measures performed best, but population-specific evaluations are needed for optimal diagnosis.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Public Health

Background:

  • Established electrocardiogram (ECG) criteria for left ventricular hypertrophy (LVH) are primarily based on non-African populations.
  • Their accuracy in Black African adults with untreated hypertension is not well-established.

Purpose of the Study:

  • To assess the diagnostic performance of existing ECG-LVH criteria against echocardiography-derived left ventricular mass index (LVMI).
  • To evaluate these criteria in Black African adults with untreated, uncomplicated hypertension within the coArtHA trial.

Main Methods:

  • Included 1,125 participants from Tanzania and Lesotho undergoing baseline ECG and focused transthoracic echocardiography (fTTE).
  • Left ventricular hypertrophy (LVH) defined by LVMI thresholds (women: >95 g/m², men: >115 g/m²).
  • Diagnostic performance evaluated using correlation, sensitivity, specificity, ROC, AUROC, and PRC analyses.

Main Results:

  • Echocardiographic LVH detected in 5% of participants.
  • Cornell voltage product (adjusted for sex) showed the strongest correlation with LVMI (rho=0.37, p<0.001).
  • Cornell voltage product-based criteria yielded the most consistent performance (AUROC ~0.76), with 64% sensitivity and 80% specificity at established cut-offs. Other criteria showed limited accuracy.

Conclusions:

  • ECG criteria demonstrated moderate association with LVMI in this cohort.
  • Cornell voltage product-based measures showed the most consistent diagnostic performance among evaluated ECG criteria.
  • Findings highlight the need for population-specific validation of ECG criteria for LVH in African populations, considering cut-off selection and clinical context.
Abstract

Keywords:
echocardiographyelectrocardiographic criteriahypertensionleft ventricular hypertrophysub-Saharan Africa

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