We’re sorry, something doesn't seem to be working properly.
Please try refreshing the page. If that doesn't work, please contact us so we can address the problem.
CMR ventriculometry for evaluation of ecg hypertrophy criteria in a preventive medicine population
© Eberle et al; licensee BioMed Central Ltd. 2011
Published: 2 February 2011
Left ventricular hypertrophy (LVH) is an important prognosticator for cardiovascular (CV) risk in persons with and without arterial hypertension. Given the high prevalence of these conditions, LVH screening is mandatory for CV prevention. Although not evaluated in a middle aged preventive medicine population, Electrocardiography (ECG) is widely used for LVH screening. Although not widely accessible as a screening technique, cardiovascular magnetic resonance (CMR) offers a unique opportunity to calculate LV mass index (LVMI) as the gold standard for other diagnostic tests.
To assess the reliability of ECG LVH criteria compared to CMR ventriculometry (cutoff: LVMI 83 g/m2) and the incremental value of CMR in a population from a prevention programme.
220 (206 male, age 49.5 ± 8,4 years) consecutive participants of a prevention programme without known heart disease underwent CMR in a 1.5 T scanner (Magnetom Avanto, Siemens, Erlangen, Germany) including SSFP Cine (TrueFISP TR 3ms, TE 1.5 ms, FA 72°, slice thickness 6 mm) and delayed enhancement imaging.
Calculation of the ECG criteria
Sokolow-Lyon Amplitude (mV)
SV1 + RV5/V6
Sokolow-Lyon Duration Product (mm * ms)
(SV1 + RV5/V6) * QRS duration
Cornell Amplitude (mV)
R aVL + SV3
Cornell Duration Product (mm + ms)
(R aVl + SV3) * QRS duration
Romhild Estes Score
R or S > 20 mm
S in V1 or V2 > 30 mm
R in V5 or V6 30 mm
ST/T changes typical of LVH, taking digitalis
ST/T changes typical of LVH, not taking digitalis
P terminal force in V1 1mm or more, duration >40 ms
Left axis deviation > -30°
QRS dura> 90 ms
Intrinsicoid deflection in V5 or V6 >50 ms
31 participants had positive LVH criteria in ECG, of which 6, and 4 ECG negatives, showed LVH (LVMI > 83 g/m2) in CMR (Figure 2). All ECG criteria were positively correlated with LV mass (Table 3). Specificities and negative predictive values were high in our low-prevalence population, but sensitivities and positive predictive values were poor (Table 3, Figure 1).
Diagnostic characteristics and correlation with LVMI of the ECG criteria
Correlation Coefficient (Perason)
Posisitive Predictive Value
Negative Predictive Value
CMR identified a large proportion of false positive ECG results (25/31), and identified additional LVH cases (4/189). ECG is not a reliable LVH screening tool in a middle aged prevention population. LVH screening should be based on imaging techniques.
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (<url>http://creativecommons.org/licenses/by/2.0</url>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.