Comparison of Four Electrocardiographic Criteria for Detecting Left Ventricular Hypertrophy in Uncomplicated Hypertension: A Cross-Sectional Study

Abstract

Electrocardiography (ECG) is widely used to screen for left ventricular hypertrophy (LVH), but its diagnostic performance varies across criteria. This cross-sectional diagnostic accuracy study compared the Cornell Product, Sokolow–Lyon, Romhilt–Estes, and Peguero–Lo Presti criteria against transthoracic echocardiography in 150 adults with uncomplicated hypertension. Left ventricular geometry was classified according to American Society of Echocardiography recommendations, and diagnostic performance was assessed using sensitivity, specificity, predictive values, and receiver operating characteristic (ROC) analysis with 95% confidence intervals (CIs). Concentric hypertrophy was the predominant pattern (51.3%). Only Romhilt–Estes and Sokolow–Lyon were significantly associated with echocardiographic LVH (p < 0.001 and p = 0.023). At conventional thresholds, all criteria showed low sensitivity (12.9%–33.3%) but high specificity (84.2%–94.7%). In ROC analysis, Peguero–Lo Presti achieved the highest, albeit modest, discrimination (AUC 0.680, 95% CI 0.566–0.793; sensitivity 78.8%), whereas Sokolow–Lyon showed the highest specificity (88.4%), with substantially overlapping CIs across criteria. ECG may serve as a practical first-line screening tool, but its modest accuracy does not permit definitive diagnosis or exclusion of LVH; echocardiography remains required for confirmation and assessment of left ventricular geometry.