Assessment of left ventricular hypertrophy in patients with essential hypertension

By virtue of its potency as a cardiovascular risk indicator, the presence of left ventricular hypertrophy (LVH) in a patient with hypertension deserves serious attention and make its diagnosis a clinical priority. In view of its prognostic impact, an argument could be made for routine assessment of this intermediate endpoint in each patient with essential hypertension. Two diagnostic approaches are available for screening evaluation of hypertensive patients; either a limited echocardiographic examination or an ECG-based LVH assessment. Recently developed new or combined criteria have significantly improved the diagnostic performance of ECG criteria, and evolving data show that accurate estimation of LVH can be performed by ECG screening in a majority of patients. At present, ECG evaluation based either on sex-specific orthogonal-lead time-voltage criteria or on the combined standard 12-lead criteria of Sokolow-Lyon (sum of S in V1 and R in V5 or V6) or Cornell Product (product of sum of R in aVL and S in V3 + 6 mm in females and QRS duration) demonstrates the best overall diagnostic accuracy. With orthogonal criteria, the sensitivity is 81% in women and 71% in men at a matched 98% specificity. The corresponding overall sensitivity of the combined Cornell Product or Sokolow-Lyon criteria is reported to be 68% at a specificity of 96.6%. What speaks in favour of the echocardiographic approach is its superior sensitivity and the possibility of gaining additional potential risk information associated with the geometric pattern of the LVH. However, its general availability makes electrocardiography a cost-effective diagnostic alternative with which to follow the progression or regression of LVH in hypertensive patients.