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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 October 20; 335(7624): 787.
PMCID: PMC2034682
Detecting LVH

Ethnicity is relevant

Andrew P Vanezis, foundation doctor1 and Raj Bhopal, Bruce and John Usher professor of Public Health2

Pewsner et al highlight the danger of using electrocardiography (ECG) for detecting left ventricular hypertrophy (LVH), particularly as it has low sensitivity.1 They conclude that no criteria are superior to the Sokolow-Lyon criteria.2 Our recent review supports the first, but not the second, conclusion.

Bourdillon (previous letter) emphasises the need to take into account age, sex, and ethnicity. In a systematic review of the literature, we identified five studies comparing the sensitivity and specificity of ECG (using the Sokolow-Lyon and Cornell criteria) for detecting LVH in white and black (African origin) populations.3 4 5

Specificity was high using both sets of criteria in white populations (Cornell 87.4%, Sokolow-Lyon 88.9%) but was much lower in black groups using the Sokolow-Lyon criteria (72.1%). Specificity was higher in black groups using the Cornell criteria (86.2%). Some evidence suggested that Cornell criteria were more sensitive than Sokolow-Lyon criteria in black populations.

Our evidence favours the Cornell criteria over the Sokolow-Lyon criteria. While we agree with Pewsner et al that ECG is not sufficient for diagnosing LVH, we emphasise that it is not equally valid across ethnic groups.


Competing interests: None declared.


Pewsner D, Jüni P, Egger M, Battaglia M, Sundström J, Bachmann LM. Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review. BMJ 2007;335:711-4. (6 October.) [PMC free article] [PubMed]
Sokolow M, Lyon TP. The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J 1949;37:161-3.
Okin PM, Wright JT, Nieminen MS, Jern S, Taylor AL, Phillips R, et al. Ethnic differences in electrocardiographic criteria for left ventricular hypertrophy: the LIFE study. Am J Hypertens 2002;15:663-71. [PubMed]
Chapman JN, Mayet J, Chang CL, Foale RA, Thom SAM, Poulter NR. Ethnic differences in the identification of left ventricular hypertrophy in the hypertensive patient. Am J Hypertens 1999;12:437. [PubMed]
Rautaharju PMMT, Siscovick D, Zhou SH, Gardin JM, Kronmal R, Furberg CD, et al. The CHS Collaborative Research Group. Classification accuracy of electrocardiographic criteria for left ventricular hypertrophy in normal weight and overweight older adults. Ann Noninvas Electrocardiol 1996;1:121-32.

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