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J Electrocardiol. 2008 Jul-Aug;41(4):342-50. doi: 10.1016/j.jelectrocard.2007.11.006. Epub 2008 Mar 14.

Thresholds in the relationship between mortality and left ventricular hypertrophy defined by electrocardiography.

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Department of Medicine, Denver Health Medical Center, Denver, Colorado 80204-4507,



Electrocardiographic criteria for the diagnosis of left ventricular hypertrophy in current use were defined using autopsy results or echocardiography; criteria defined using mortality might be more clinically meaningful.


Using data from Third National Health and Nutrition Examination Survey (NHANES III), we selected electrocardiographic measures that best differentiated those surviving at 5 years from those who did not. We identified voltage thresholds using regression techniques and then compared survival for subjects above and below the thresholds.


Cornell voltage, Cornell product, and Novacode estimate of left ventricular mass index were discriminative for mortality and had identifiable thresholds present in their relationships with mortality. Independent of systolic blood pressure, there were significant associations with 5-year mortality for Novacode index above threshold; hazard ratios were 1.58 for women and 1.27 for men, and for 5-year cardiovascular mortality were 1.78 for women and 2.34 for men.


Electrocardiographic criteria for left ventricular hypertrophy validated against mortality might be clinically useful.

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