Butler, Leggett, et al provided criteria for changes in the electrocardiogram associated with right ventricular hypertrophy in patients with mitral valve stenosis. These criteria allow identification of moderate to severe right ventricular hypertrophy in about two-thirds of the patients affected.
Patients: Adults between the age of 20 and 69 years of age, with equal numbers of men and women.
Criteria 1
anterior value A = MAX (R or R’ in V1, R or R’ in V2)
right value R = MAX (S in I, S in V6)
posterolateral value PL = MIN (S in V1, R in I, R in V6)
(A + R - PL) >= 0.70 mV indicates right ventricular hypertrophy.
where:
• 1 mm = 0.1 mV
Criteria 2
R <= 0.2 mV in lead I
Criteria 3
P > 0.25 mV in leads II, III, aVF, V1 or V2
Interpretation
Evaluation
Sensitivity
Specificity
Criteria 1
34%
96.6%
Criteria 2
40%
98.4%
Criteria 3
22%
99.4%
Criteria 1 + 2 + 3
64%
94%
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