Schillaci et al developed a score for detecting left ventricular hypertrophy in a patient with essential hypertension. The authors are from Perugia, Italy.

Criteria for the Perugia score - presence of one or more of the following in a 12 lead ECG:

(1) left ventricular strain

(2) Romhilt-Estes score >= 5

(3) Cornell criteria with elevated voltage sum of S in V3 and R in aVL



• The 1st and 3rd criteria are the same as the C/S index in the previous section. The cutoff for males with the C/S index and Perugia score are lower than with the original Cornell criteria.

• The score for the Romhilt-Estes score is the score associated with LVH.


voltage sum =

= (S in V3 in mV) + (R in aVL in mV)



Positive If


> 2.4 mV


> 2.0 mV


Left ventricular strain is seen in V2 to V6, aVL, I and II. Changes include:

(1) >= 0.1 mV ST segment depression (this is greater than in the C/S index)

(2) asymmetric T wave inversion



• The sensitivity is 34% with a specificity of 93%.


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