Electrocardiographic prediction of left ventricular geometric patterns in patients with essential hypertension

Background The present study sought to determine the diagnostic value of electrocardiographic voltage criteria in predicting geometry patterns in patients with essential hypertension. Methods Patients with essential hypertension (n = 125) according to left ventricular mass index and relative wall thickness as determined by echocardiography were assigned in the following groups: normal geometry (N, n = 50), concentric remodeling (CR, n = 12), concentric hypertrophy (CH, n = 28) and eccentric hypertrophy (EH, n = 35). Each patient underwent 12-lead ECG followed by determination of conventional voltage criteria as well as peak to peak QRS lengths in each lead. Results Voltage criteria such as Sokolow–Lyon, Cornell, Cornell product > 2440, D1R + D3S > 25 mm, and AVL R > 11 mm could not significantly predict and discriminate geometric patterns of LVH. However, they all were very specific (range 97–100%) and showed very high positive predictive values (range 94–100%) for detecting abnormal geometry. DI peak > 12 mm had a sensitivity 61%, specificity 67%, accuracy 63%, positive predictive value 81%, and negative predictive value 42% in predicting to differentiate CH from CR. Sum of the calculated values from the peak of the R to the nadir of the S wave in all limb leads > 60 mm had sensitivity 68%, specificity 75%, accuracy 70%, positive predictive value 86% and negative predictive value 50% in predicting to differentiate CH from CR. Conclusions Conventional ECG voltage criteria could not significantly discriminate specific geometry patterns observed in patients with essential hypertension.