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

2. 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: )
• 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

3. 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 = (SV3 + RaVL) TV, QRS PTFV-, (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

4. 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)

5. 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

6. LEFT VENTRICULAR HYPERTROPHY
• Novacode criteria
• LVMI (g/m2) = R V S V S T(neg) V T (pos) aVR 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

7. 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

8. 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

9. 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

10. 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 V s 8

11. 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

12. 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.

13. 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