SD + SV4 diagnosis of left ventricular hypertrophy, a revaluation of ECG criterion by cardiac magnetic resonance imaging

Ann Noninvasive Electrocardiol. 2021 Jul;26(4):e12832. doi: 10.1111/anec.12832. Epub 2021 Feb 23.


Backgroud: Present electrocardiogram (ECG) criteria for diagnosing left ventricular hypertrophy (LVH) usually have low sensitivity, while the newly proposed SD + SV4 criterion, namely the deepest S-wave amplitude in any lead (SD) plus SV4 amplitude, has been reported to have higher sensitivity and accuracy compared with other existing criteria. We aimed to further evaluate the diagnostic value of the SD + SV4 criterion in reference to the gold standard cardiac magnetic resonance imaging (CMR) in LVH diagnosis.

Methods: This retrospective study enrolled 138 patients who received CMR examination-60 patients with reduced ejection fraction (EF) and 78 patients with preserved EF. The left ventricular mass index (LVMI) measured by CMR was used as the gold standard for diagnosing LVH.

Result: The diagnostic value of the SD + SV4 criterion was compared with other 4 commonly used criteria. By CMR, 29 out of 138 people (21%) were diagnosed with LVH in reference to CMR. The SD + SV4 criterion had markedly higher sensitivity in diagnosing LVH compared with other criteria, but no higher specificity. There was no significant difference in area under receiver operating characteristic (ROC) curve among these criteria. The SD + SV4 criterion was not markedly consistent with CMR in diagnosing LVH. Compared to the other criteria, the SD + SV4 criterion had the highest sensitivity in patients with reduced ejection fraction; however, the area under the curve (AUC) of the SD + SV4 criterion in patients with reduced EF was significantly lower than in patients with preserved EF.

Conclusion: The newly proposed SD + SV4 criterion did not have a better diagnostic value compared with other existing criteria, and the statistical power of the SD + SV4 criterion was influenced by EF.

Keywords: CMR; SD + SV4 criterion; electrocardiography; left ventricular hypertrophy; left ventricular mass index.

MeSH terms

  • Electrocardiography*
  • Heart
  • Humans
  • Hypertrophy, Left Ventricular* / diagnostic imaging
  • Magnetic Resonance Imaging
  • Retrospective Studies
  • Sensitivity and Specificity