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)


Positive If


> 2.4 mV


> 2.0 mV



• 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)



• The index achieved a population-attributable risk of 16% for cardiovascular events.


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