STANDARD ELECTROCARDIOGRAPHIC CRITERIA FOR LEFT VENTRICULAR HYPERTROPHY IN NIGERIAN HYPERTENSIVES Objectives: Left ventricular hypertrophy (LVH) is a major risk factor for cardiovascular morbidity and mortality. Various electrocardiographic cri- teria for LVH have differing sensitivities and specificities. Most of the available electrocardio- graphic criteria for LVH have not been evaluat- ed in the African populace. Methods: Electrocardiograms (ECGs) and echocardiograms were obtained from 100 hypertensive subjects and 60 controls. Electro- cardiogram (ECG) LVH was determined by the Sokolow-Lyon, Sokolow-Lyon-Rappaport, Cor- nell voltage, Romhilt-Estes point score, and the Perugia score criteria. Echocardiographic LVH was defined by LV mass indexed for height at 97.5 percentile of the controls (126 g/m and 130 g/m in females and males respectively). Results: The prevalence of echocardiographic LVH indexed for height was 34% and 1.67% in the hypertensive patients and controls respec- tively. The prevalence of ECG LVH obtained in the hypertensive patients with the various ECG criteria were 56% for Sokolow-Lyon-Rappa- port voltage, 48% for Sokolow-Lyon voltage, 41% for Perugia score, 22% for Cornell sex specific voltage, and 18% for Romhilt-Estes score. Sokolow-Lyon-Rappaport voltage crite- ria had the best sensitivity (80%) and area under the receiver operating characteristic (ROC) curve while the Romhilt-Estes score had the best specificity (93%). Conclusion: Sokolow-Lyon and Sokolow- Lyon-Rappaport voltage criteria combine the best sensitivity and specificity values and would seem better suited for the diagnosis of ECG LVH in Nigerians. (Ethn Dis. 2005; 15:578–584) Key Words: Electrocardiogram, Hyperten- sion, Left Ventricular Hypertrophy, Nigeria, Sensitivity, Specificity Adekola Dada, FWACP; Adewole A. Adebiyi, FWACP; Akinyemi Aje, FMCP; Olulola O. Oladapo, FWACP; Ayodele O. Falase, FRCP INTRODUCTION Left ventricular hypertrophy is a ma- jor complication of sustained arterial hypertension. 1 Numerous studies show that left ventricular hypertrophy diag- nosed by the electrocardiogram (ECG) is a blood pressure-independent risk factor for sudden cardiac death, acute myocardial infarction, and cardiovascu- lar morbidity and mortality. 2,3 Conse- quently, the detection of left ventricular hypertrophy becomes an important part of the cardiovascular assessment of hypertensive patients. The electrocardiogram was long been the major means of detecting left ventricular hypertrophy, until the ad- vent of echocardiography. While the ECG is relatively cheap and rapid, the numerous ECG criteria for the di- agnosis of left ventricular hypertrophy with their different sensitivities and specificities when compared with a gold standard make it of limited value in correctly diagnosing left ventricular hypertrophy. On the other hand, echocardiography, though more expen- sive, has been standardized and corre- lates closely with autopsy-validated left ventricular mass measurements and is thus of superior benefit in the di- agnosis of left ventricular hypertro- phy. 4 However, the expense of echocardi- ography, coupled with its relative un- availability in most developing countries, indicate that most parts of the world would have to depend on ECG for the diagnosis of left ventricular hypertrophy. Significant racial differences also exist in the structure and function of the left ventricle 5,6 and most of the previously defined criteria for the detection of left ventricular hypertrophy has been done in the Caucasian population. Therefore, the intention of this study is to appraise some ECG criteria in the diagnosis of left ventricular hypertrophy by using echocardiography as the gold standard. This would assist in recommending any of these ECG criteria which may be most applicable in making a diagnosis of hypertensive left ventricular hypertrophy in Nigeria, where dearth and the expense of echocardiographic facilities limit its routine use for the diagnosis of left ventricular hypertrophy. MATERIALS AND METHODS The study was carried out in the Cardiology Unit of the Department of Medicine, University College Hospi- tal, Ibadan. All consecutive and eligible adult hypertensive patients age $18 years of both sexes seen in the cardiology clinic were recruited for the study. Subjects were excluded from the study if they had evidence of valvular heart diseases, pregnancy, chronic renal failure, diabetes mellitus, anemia, or were athletic. From the Department of Medicine, University College Hospital (AD, AAA, OOO, AOF, AA); Department of Medicine, College of Medicine, University of Ibadan (AAA, OOO, AOF); Ibadan Nigeria. Address correspondence and reprint requests to Adewole A. Adebiyi, FWACP; Department of Medicine, College of Med- icine; University of Ibadan; University Col- lege Hospital; Ibadan Nigeria; 234-803- 347-1650; 234-2-241-1768; wadebiyi@ comui.edu.ng The intention of this study is to appraise some ECG criteria in the diagnosis of left ventricular hypertrophy by using echocardiography as the gold standard. 578 Ethnicity & Disease, Volume 15, Autumn 2005