Predicting MACE in the General Population Using LVH Electrocardiographic Criteria

heart ecg
heart ecg
Different electrocardiographic criteria used to evaluate LVH were found to be valuable for the prediction of MACE in the general population.

Different electrocardiographic criteria used to evaluate left ventricular hypertrophy (LVH), particularly the Cornell voltage, were found to be valuable for the prediction of major adverse cardiovascular events (MACEs) in the general population, according to a study published in the Journal of Electrocardiology.

Investigators searched the PubMed and Embase databases through May 9, 2020, to identify observational studies in which the value of Sokolow-Lyon voltage, Cornell voltage, or Cornell product to predict MACE was evaluated. The 10 eligible studies (n=58,400) had sample sizes ranging between 475 and 16,253 participants, with a mean age of 43.2 years, follow-up durations between 5.0 and 17.8 years, and had MACEs, cardiovascular mortality, or all-cause mortality as outcomes.

The pooled risk ratios (RR) for MACE were: 1.62 (95% CI, 1.40-1.89) for the Sokolow-Lyon voltage criteria, 1.70 (95% CI, 1.27-2.29) for the Sokolow-Lyon voltage criteria, and 1.56 (95% CI, 1.17-2) for the Cornell product criteria, when comparing participants with vs without electrogardiographic LVH.

The pooled RR FOR all-cause mortality were: 1.47 (95% CI, 1.10-1.97) for the Sokolow-Lyon voltage criteria, and 1.87 (95% CI, 1.29-2.71) for the Cornell voltage criteria. The pooled RR for cardiovascular mortality were: 1.38 (95% CI, 1.19-1.60) for the Sokolow-Lyon criteria, 1.66 (95% CI, 1.24-2.33) for the Cornell voltage criteria, and 1.82 (95% CI, 0.65-5.09) for the Cornell product criteria.

“Electrocardiographic LVH detected by the Cornell voltage appeared to have a stronger value in predicting cardiovascular or all-cause mortality,” noted the researchers. “Electrocardiographic LVH detected by the Sokolow-Lyon voltage, Cornell voltage or Cornell product had a similar value in predicting MACEs…. There may be no clear association between electrocardiographic LVH determined by Cornell product and cardiovascular mortality in the general population.”

Limitations of the analysis include the fact that studies examined did not clearly state whether the presence of electrocardiographic LVH was supported by echocardiographic criteria, and that it solely focused on traditional electrocardiographic voltage criteria.

“Including the increased QRS voltage and QRS duration (which are traditionally considered as electrocardiographic LVH criteria) could improve risk stratification of the general population,” the researchers concluded.


You Z, He T, Ding Y, et al. Predictive value of electrocardiographic left ventricular hypertrophy in the general population: A meta-analysis. J Electrocardiol. 2020;15;62:14-19.