Evaluation of Electrocardiographic Criteria of Left Ventricular Hypertrophy in Koreans

As a part of fundamental studies for establishing appropriate electrocardiographic criteria of left ventricular hypertrophy for Koreans, 39 various criteria proposed by 25 authors were applied to 500 Koreans and the reliability of each criterion was analysed based upon cardiothoracic ratios in the chest teleroentgenograms. The subjects analysed in this study included cardiac and non-cardiac patients as well as healthy adults: in all of them electrocardiograms and chest roentgenograms were obtained on the same day.

Both true and false positivities of the precordial voltage criteria were extremely high, whereas those of voltage criteria of the extremity leads and the remainder of various criteia were qutie low except for the point score system of Romhilt and Estes, which revealed relatively high true positivity and low false positivity.

True positivities of all precordial voltage criteria were higher in males than in females. Their false positivities were also higher in males, except for criteria SV₁≧24mm, RV₁≦1mm and RV₆>RV₅, which were higher in females. No significant differences were noted between males and females, however, in the true and false positivities in the voltage criteria of the extremity leads. True and false positivities of the other criteria excluding various voltage criteria were also slightly higher in males than in females. In females, true positivities of the precordial voltage criteria were not closely related to the cardiothoracic ratios, whereas those of voltage criteria of the extremity leads and of the other criteria excluding voltage criteria were higher in those with greater cardiothoracic ratios. In males, however, true positivities of nearly all the criteria, including precordial voltage criteria, were higher in those with increased cardiothoracic ratios. In both males and females, criteria SV₁≧24mm, RV₁≦1mm, RV₅≧33mm, RV₆>RV₅, RV₆≧26mm, ventricular activation time(VAT) and left axis deviation(LAD) revealed low true and false positivities indicating that these criteria were of little practical values. In females, true positivitieies of criteria RaVF≧20mm or 21mm and VAT in V_5-6≧0.66sec. were zero, indicating that these criteria were totally impractical. Both true and false positivities of almost all precordial voltage criteria were higher in Koreans than in Westerns but those of the voltage criteria of the extremity leads were similar in both groups. The remainder of the criteria revealed lower true positivities in Koreans than in Westerns but false positivities were similar in both groups. These facts denote that higher false positivities of electrocardiographic criteria of left ventricular hypertrophy proposed by the western authorities, when applied to Koreans, are mainly due to the precordial voltage criteria.

Criteria with a high true positivity and low false positivity indicating., more reliable and more appropriate for Korean males, were RV₆>20mm, RV5-6≧27mm and SV2+RV5-6>45mm in the precordial leads, RaVL≧7.6mm in the extremity leads and point score system. In females, they were similar to those in males except that criterion SV₁+RV_5-6>35mm was more appropriate than SV₂+RV_5-6>45mm. However, these selected criteria also revealed higher false positivities in Koreans than in Westerns, and obviously still further studies are needed to establish more reliable criteria for Koreans.