ECG criteria's for ventricular hypertrophy Dessert session Dr NAIR ANISH

LEFT VENTRICULAR HYPERTROPHY • Sokolow-Lyon index:(Am Heart J, 1949;37:161) • S in V1+ R in V5 or V6 > 35 mm • R in aVL > 11 mm • Framingham criteria (Circulation,1990; 81:815-820) • R avl > 11mm • R V4-6 > 25mm • R I + S III > 25 mm • S V1-3 > 25 mm • S V1 or V2 + R V5 or V6 > 35 mm

LEFT VENTRICULAR HYPERTROPHY • Cornell voltage cr\ter\a(Circulation, 1987;3:565-72) • S in V3 + R in aVL > 28 mm (men) • S in V3 + R in aVL > 20 mm (women) Cornell regression equation : • Risk of LVH = 1/(1+ e-exp) • [exp = 4.558 - 0.092 (SV3 + RaVL) - 0.306 TV, - 0.212 QRS - 0.278 PTFV-, - 0.559 (gender)] • Cornell voltage duration measurement : • QRS duration x Cornell voltage > 2,436 mm-sec • QRS duration x sum of voltages in all leads > 1,742 mm-sec

LEFT VENTRICULAR HYPERTROPHY Romhilt-Estes score ECG Criteria Points Voltage Criteria (any of): R or S in limb leads >20 mm S in Vx or V2 >30 mm R in V5 or V6 >30 mm 3 •ST-T Abnormalities: ST-T vector opposite to QRS without digitalis ST-T vector opposite to QRS with digitalis 3 1 Negative terminal P mode in Vx 1 mm in depth and 0.04 sec in duration Left axis deviation (QRS of -30° or more) 2 QRS duration >0.09 sec 1 Delayed intrinsicoid deflection in V5 or V6 (>0.05 sec)

Sensitivity (%) Specificity (%) Framingham criteria RI + SIII>25 mm 10.6 100 RVL > 11 mm 11 RV5-V6>26 mm 25 98 Sokolow'-Lyon 22 Cornell voltage criterion 42 96 voltage duration measurement 51 95 Romhilt-Estes score - 4 points 55 85 > 5 points 35 In W6, deepest S + tallest R >45 mm 45 93 RVL > 7.5 mm

LEFT VENTRICULAR HYPERTROPHY • Novacode criteria • LVMI (g/m2) = -36.4 + 0.01 R V5 + 0.2 S V1 + 0.28 S 3 + 0.182 T(neg) V6 - 0.148 T (pos) aVR + 1.049 QRS duration • Seigel's Total QRS voltage criteria • Sum of QRS voltages in all leads >179 mm • Voltage criteria x QRS duration > 17472 • Hernandez partial voltage criterion • Sum of QRS voltages in all leads >120 mm

LEFT VENTRICULAR HYPERTROPHY • Natural history series -2 • QRS duration <120 ms + > 1 of following • R or S in limb leads > 20 • S VI > 30 or R V6 > 30 mm • The Talbot criterion • R aVL > 16 mm The Koito and Spodick criterion • R V6 > R V5

LVH with LBBB LVH with LAHB • concomitant left atrial abnormality • QRS duration > 160 ms • SV1-2 + RV5-6 > 45 mm (sensitivity 86% and specificity 100%) LVH with LAHB • Max R/S in precordial leads + S3 >30 (men) / > 28 (women) • Specificity 87% , Sensitivity 96%, PPV 89% and NPV 95% • S V1/2 + (R +S)V5/V6 > 25 • R Avl > 13 mm

LVH with RBBB • Max R/S precordial lead (with LAD) >29mm • S III+max R/S precordial (with LAD) >40 mm • S V1 >2mm • R 1 >11 mm • R V5/6 >15 mm • Sokolow index > 35 mm ( Specificity 100% ) • LAE

RIGHT VENTRICULAR HYPERTROPHY Criterion SENSITIVITY (%) Specificity (%) Vi R/S in Vx> 1 with R > 0.5 mV 6 98 R in V1> 0.7 mV 2 99 qR in V1 5 S in V1 <2 mm IDT in V1 0.35 s 8

H RIGHT VENTRICULAR HYPERTROPHY 93 Criterion Sensitivity (%) Specificity (%) Vs-V6 R/S in V5 or V6 < 1 16 93 H S in V5 or V6 > 0.7 mV 26 90 R V5-V6 <5 mm 13 87 Vi + V6 RV1 + SV5-V6 >10.5 mm R in V5 or V6 > 0.4 mV with S in V1 < 0.2 mV AQRS 110° 15 96 si, sii, siii 24 P pulmonale

RVH IN RBBB • Incomplete RBBB • Complete RBBB • An rsR' complex in V 1 (R' > 10 mm), with a QRS duration of < 0.12 seconds. • R' > r with assymetric negative T V2/3 and RAD • Complete RBBB • Barker and Valencia criteria : R' > 15 mm • Milnor criteria • Frontal QRS axis +110 to +270 • R'/S V1 > 1 ( provided R' V1 > 5 mm) • QRS > 140 msec • RAD • R/S ratio in lead I is < 0.5.

Biventricular Enlargement • Rs in V5/V6 + rSR' pattern in V± + P wave of biatrial enlargement • Tall R wave in V5/6 with QRS axis > 90 • Diphasic RS complexes in midprecordial leads > 50 mm (Katz-Wachtel phenomenon) • sV-l + S V2 + R V5/6, + AQRS shifted to the right or S-, SM-, Sm • QRS complexes within normal limits but with significant repolarization abnormalities (negative T wave and depression of the ST segment), mainly when the patient presents with atrial fibrillation