Comparison of Electrocardiographic Criteria With Echocardiographic Parameters For Detection of Left Ventricular Hypertrophy in Hypertensive And Non-Hypertensive Patients – A Cross Sectional Study

Abstract

BACKGROUND: Left ventricular hypertrophy is an important marker of Cardiovascular risk and is commonly associated with hypertension. Electrocardiography (ECG) is widely available and inexpensive for screening LVH, but conventional ECG criteria may have limited sensitivity. Echocardiography Permits direct assessment of left ventricular structure and quantification of Left ventricular mass.

OBJECTIVE: To compare commonly used ECG criteria with echocardiographic parameters for detection of LVH and to evaluate the influence of hypertension on LVH detection.

METHODS: A prospective cross – sectional study was conducted among 138 adults at VELS Medical College and Hospital over 6 month period from september 2025 to February 2026. All participants underwent standard 12 – lead ECG and comprehensive transthoracic echocardiography. ECG evidence ofLVH was assessed using Sokolow – Lyon, Cornell voltage, Romhilt – estes criteria. Echocardiographic assessment included interventricular sepal thickness in diastole, left ventricular posterior wall thickness in diastole ,left ventricular internal diameterin diastole ,left ventricular mass, relative wall thickness , left ventricular ejectionfraction diastolic parameters, left atrial size, and pulmonary artery systolic pressure . participants were classified according to echocardiographic LVH status and further compared according to hypertensive status. Sensitivity, specificity, positive predictive valve, negative predictive valve, and accuracy were calculated for the ECG criteria.

RESULTS: Of 138 participants, 99 had echocardiographic LVH and 39 were classified as controls.Mean age was significantly higher in the LVH group than in the control group(60.25±10.45 vs 50.00± 13.70 years; p < 0.001). hypertension was significantly more prevalent in participants with LVH than in controls( 747% vs 43.6%;p <0.001). LVM, IVSd, LVPWd, LVIDd, left atrial size, and pulmonary artery systolic pressure were higher in the LVH group,while LVEF and tissue Doppler E’ velocity were lower. Among ECG criteria, sokolow-lyon showed the highest sensitivity(46.7%) and accuracy (57.2%), whereas Romhilt – Estes demonstrated the highest specificity (92.3%). Cornell criteria showed a sensitivity of 30.3%, specificity of 89.7%, and accuracy of 47.1%.

CONCLUSION: Hypertension was significantly associated with echocardiographic LVH. Conventional ECG criteria demonstrate relatively low sensitivity despite good specificity. Sokolow – lyon showed the best sensitivitry and overall accuracy, whereas Romhilt – Estes showedthe highest specificity. Echocardiography remains more useful for identification and quantification ofstructural LV remodeling, while ECG can serve asa an accessible screening tool.