Left Ventricular Hypertrophy

Updated October 23, 2019

Background | Causes | Diagnostic Criteria | Associated Findings | Examples | Further Reading

Background

• The free wall typically grows the most, which directs more forces backwards, upwards, and left.  (Leftward Axis)

Causes

• Acquired (Aortic Valve Disease, Hypertension)
• Cardiomyopathies (Ischemic CMP, Genetic CMP)
• Congenital Heart Disease (AS, Coarctation, fibroelastosis)

Criteria

Cornell Criteria:

• R in aVL + S in V3 > 24mm in men, > 20mm in women
• (Sensitivity: 22%, Specificity: 100%)

Sokolow-Lyon Criteria:

• S in V1 + R in V5-6 ≥ 35mm
• (Sensitivity: 42% Specificity: 96%)

Sokolow Index (aka “aVL Criteria”)

• aVL ≥ 11mm
• (Sensitivity: 9-13%, Specificity 99%)

Diagnosing Scoring Systems: (rarely used in practice)

• i.e. Estes Score (scores ST changes, voltage criteria, and negative P-waves) and calculates probability of LVH

Associated Findings

• Repolarization changes (ST depression, TWI) (i.e. strain pattern)
• Atrial Fibrillation
• Left Atrial Enlargement

Examples

Further Reading

• Hancock EW, Deal BJ, Mirvis DM, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy. Journal of the American College of Cardiology. 2009; 53(11):992-1002.