Verdecchia et al developed an index for identifying patients with hypertension who have left ventricular hypertrophy and who are at increased risk for a cardiovascular event. This is based on the presence of the Cornell criteria (above) or evidence of strain in the ECG. The authors are from the Universita di Perugia-Ospedale Silvestrini, University of Perugia and Ospedale Beato G Villa in Perugia, Italy.
The index is considered positive if one or both of the following are present:
(1) evidence of LVH using the Cornell criteria
(2) evidence of left ventricular strain in the ECG
Cornell Voltage Criteria
voltage sum =
= (S in V3 in mV) + (R in aVL in mV)
Gender
Positive If
male
> 2.4 mV
female
> 2.0 mV
where:
• The cutoff for the voltage sum in males in the original paper by Casale et al was > 2.8 mV rather than 2.4 mV. The cutoff for females is the same.
Left Ventricular Strain
Criteria for strain - the presence of both of the following:
(1) ST-J segment depression <= 0.05 mV
(2) inverted T wave
Location of strain - in one or more of the following leads:
(1) I
(2) II
(3) aVL
(4) V2 to V6 (in the implementation will use at least 4 out of the 5 leads)
Performance:
• The index achieved a population-attributable risk of 16% for cardiovascular events.
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