A comparison of cornell and sokolow-lyon electrocardiographic criteria for left ventricular hypertrophy in korean patients

Abstract

Background and objectives: Electrocardiography (ECG) is a cost-effective and useful method for diagnosing left ventricular hypertrophy (LVH) in a large-scale study or in clinical practice. Among ECG criteria, the Cornell product (Cor P) and Sokolow-Lyon criteria were adopted by the European Society of Hypertension-European Society of Cardiology Guidelines but have different performances among races. The aim of this study was to compare the diagnostic performance of two voltage criteria in Korean patients.

Subjects and methods: Electrocardiography and echocardiographic LV mass of 332 (159 male, 173 female) consecutive patients were analyzed. Cornell voltage criteria and the Cor P were compared with Sokolow-Lyon voltage (Sok V) and the Sokolow-Lyon product (Sok P). The sensitivities and specificities were estimated using a receiver-operating characteristics (ROC) curve in relation to the LVH diagnosis. The sensitivities and revised cut-off values were derived at specificity levels of 90, 95, and 100%.

Results: The Cornell-based criteria generally showed better performance than that of the Sok V criteria and Sok P in the area under the ROC curve analysis. The revised cut-off values for the Cornell voltage criteria (20 and 16 mm for males and females, respectively) showed an improved sensitivity (19.7 and 30.3% for males and females, respectively), with a high specificity of 95%.

Conclusion: The Cornell-based criteria had better performance than that of the Sokolow-Lyon criteria in both Korean men and women. However, revised cut-off values are needed to improve accuracy.

Keywords: Echocardiography; Electrocardiography; Hypertrophy, left ventricular; Sensitivity and specificity.

Fig. 1

Receiver operating characteristic (ROC) curve with four electrocardiogram criteria for detecting left ventricular hypertrophy (LVH). A: the ROC curve for defining LVH using left ventricular mass (LVM)/body surface area (BSA) ≥116 g/m² in males. B: LVM/BSA ≥96 g/m² in females. C: LVM/height^2.7 ≥49 g/m^2.7 in males. D: LVM/height^2.7 ≥45 g/m^2.7 in females. ^*p<0.05, ^†p<0.01. blue: Sok V, brown: Sok P, orange: Cor V and green: Cor P. Sok V: Sokolow-Lyon voltage, Cor V: Cornell voltage, Sok P: Sokolow-Lyon product, Cor P: Cornell product, CI: confidence interval, AUC: area under the curves.