BMJ  2007;335:787 (20 October), doi:10.1136/bmj.39367.394155.BE

Letters

Detecting LVH

QRS voltage criteria can be useful

The first 150 words of the full text of this article appear below.

Pewsner et al take no account of age or race when assessing accuracy of electrocardiography (ECG) for diagnosing left ventricular hypertrophy (LVH).¹ Ignoring them reduces specificity,² and results in ?disease of electrocardiographic origin? in screening programmes. In particular, the upper normal limits of QRS voltages in black men are greater than in white men, while the difference between black and white women increases with age.³

We routinely report upper limits of normal QRS voltage for RaVL, RaVL+SV3, and RV5+SV1 on all ECG referrals for hypertension. These upper limits of normal are calculated as the mean plus 2 standard deviations from data in Rautaharju et al.³ A diagnosis of LVH is suggested if any value is greater than the age, sex, and race adjusted upper normal limit. When we compared the Pewsner criteria with our criteria in a recent sample of patients (table), the Pewsner criteria resulted in roughly twice . . . [Full text of this article]

ECG Department, Hammersmith Hospital, London W12 0HS

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Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review

Daniel Pewsner, Peter Jüni, Matthias Egger, Markus Battaglia, Johan Sundström, and Lucas M Bachmann
BMJ 2007 335: 711. [Abstract] [Full Text] [PDF]