Comparative study of echocardiography and electrocardiography criteria for detecting left ventricular hypertrophy in hypertensive patients

Abhishek Golla, Ramkumar V. S., Ashok Kumar P., Ravindranath S., Indira Ramaiah, Veena N., Rajashekar R. Gurala, Kazi Jawad Hussain, Vikram Adithya


Background: The study aimed to compare seven different electrocardiogram (LVH) criteria for diagnosing left ventricular hypertrophy (LVH) with echocardiogram as diagnostic standard in hypertensive patients.

Methods: This was a hospital-based, cross-sectional study conducted in out-patient department and at medical wards of a tertiary care hospital at Bangalore. The study was carried out for a total duration of 12 months. All hypertensive patients underwent examination for prevalence of LVH using echocardiogram and ECG. Seven different ECG criteria were applied to diagnose the presence of LVH. Then the specificity, sensitivity, kappa measurement value, positive predictive value and negative predictive value for all criteria was calculated subsequently.

Results: Out of the 100 patients studied, 34 had LVH as diagnosed by echocardiography. Sokolow-Lyon criteria had a sensitivity of 35% and specificity of 94%. Cornell voltage had a sensitivity of 26% and specificity of 95%. Modified Cornell voltage had a sensitivity of32% and specificity of 94%. Framingham adjusted Cornell voltage, Minnesota code and Cornell product had a sensitivity of 23.5% and specificity of 98.4%. Framingham score had a sensitivity of 38% and specificity of 95.4%.

Conclusions: It can be concluded that among all the different criteria used in the study, Framingham score showed better sensitivity compared to others. In the evaluation of hypertensive patients for LVH, the role of ECG with all the commonly used criteria is of limited value and echocardiography is the method of choice.


Echocardiography; Electrocardiography; Hypertension; Left ventricular hypertrophy

Full Text:



Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. International Society of Hypertension global hypertension practice guidelines. Hypertension. 2020;75(6):1334-57.

Aronow WS. Hypertension and left ventricular hypertrophy. Ann Translat Med. 2017;5(15).

Katholi RE, Couri DM. Left ventricular hypertrophy: major risk factor in patients with hypertension: update and practical clinical applications. Int J Hypertens. 2011;2011.

Cuspidi C, Sala C, Negri F, Mancia G, Morganti A. Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies. J Hum Hypertens. 2012;26(6):343-9.

Hancock EW, Deal BJ, Mirvis DM, Okin P, Kligfield P, Gettes LS. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: Part V: electrocardiogram changes associated with cardiac chamber hypertrophy a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol. 2009;53(11):992-1002.

Pewsner D, Jüni P, Egger M, Battaglia M, Sundström J, Bachmann LM. Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review. BMJ. 2007;335(7622):711.

Bacharova LM, Schocken D, Estes E, Strauss D. The role of ECG in the diagnosis of left ventricular hypertrophy. Curr Cardiol Rev. 2014;10(3):257-61.

Reichek N, Devereux RB. Left ventricular hypertrophy: relationship of anatomic, echocardiographic and electrocardiographic findings. Circulation. 1981;63(6):1391-8.

Norman Jr JE, Levy D. Adjustment of ECG left ventricular hypertrophy criteria for body mass index and age improves classification accuracy: the effects of hypertension and obesity. J Electrocardiol. 1996;29:241-7.

Casale PN, Devereux RB, Kligfield P, Eisenberg RR, Miller DH, Chaudhary BS, et al. Electrocardiographic detection of left ventricular hypertrophy: development and prospective validation of improved criteria. J Am Coll Cardiol. 1985;6(3):572-80.

Okin PM, Roman MJ, Devereux RB, Kligfield P. Electrocardiographic identification of increased left ventricular mass by simple voltage-duration products. J Am Coll Cardiol. 1995;25(2):417-23.

Morrison I, Clark E, Macfarlane PW. Evaluation of the electrocardiographic criteria for left ventricular hypertrophy. Anatol J Cardiol. 2007;7.

Mahn JJ, Dubey E, Brody A, Welch R, Zalenski R, Flack JM, et al. Test characteristics of electrocardiography for detection of left ventricular hypertrophy in asymptomatic emergency department patients with hypertension. Acad Emerg Med. 2014;21(9):996-1002.

Kannel WB, Gordon T, Offutt D. Left ventricular hypertrophy by electrocardiogram: prevalence, incidence, and mortality in the Framingham study. Ann Intern Med. 1969;71(1):89-105.

Kannel WB. Prevalence and natural history of electrocardiographic left ventricular hypertrophy. Am J Med. 1983;75(3):4-11.

Gordon T, Kannel WB. Premature mortality from coronary heart disease: the Framingham Study. JAMA. 1971;215(10):1617-25.

Kannel WB, Doyle JT, McNamara PM, Quickenton P, Gordon T. Precursors of sudden coronary death. Factors related to the incidence of sudden death. Circulation. 1975;51(4):606-13.

Aronow WS, Schwartz KS, Koenigsberg M. Value of five electrocardiographic criteria correlated with echocardiographie left ventricular hypertrophy in elderly patients. Am J Noninvas Cardiol. 1987;1:152-4.

Khaznadar AA, Ahmed FJ, Tahir K, Kakamad FH. Left ventricular hypertrophy in hypertensive patients: prevalence and diagnosis. Cardiol. 2018;4:1-7.