Day-to-day variability of voltage measurements used in electrocardiographic criteria for left ventricular hypertrophy

Department of Medicine, New York Hospital-Cornell Medical Center, New York.

Although electrocardiographic (ECG) voltage can be used to estimate left ventricular mass, day-to-day variability of voltage combinations used for this purpose must be established before ECG changes are taken as evidence of progression or regression of hypertrophy. Accordingly, serial ECGs (mean 8 days apart), derived from 10 s samples digitized at 250 Hz, were examined in 78 patients with no intercurrent change in clinical status. The coefficient of variation was calculated as 1 SD of the difference between paired voltage measurements, divided by the average mean value. Coefficient of variation for single leads was 22.3% for SV1, 27.0% for RV5 or RV6, 27.1% for RaVL and 34.7% for SV3. Coefficient of variation was lower for voltage combinations than for individual lead measurements: 18.5% for Sokolow-Lyon voltage (SV1 + RV5 or RV6), 22.3% for Gubner-Ungerleider voltage (R1 + S3) and 24.8% for Cornell voltage (RaVL + SV3). Serial reclassification due to variation above and below standard criteria for left ventricular hypertrophy occurred in only 3% of patients for Sokolow-Lyon voltage and 4% of patients for Cornell voltage in this group. Minute to minute reproducibility of voltage was assessed with electrodes in place in a separate group of 26 patients, and the coefficient of variation was 2.6% for Sokolow-Lyon voltage, 5.9% for Gubner-Ungerleider voltage and 2.9% for Cornell voltage. These data indicate that serial variability of computer-measured ECG voltage combinations is high, due primarily to changes in lead placement and body position, but less than the variability of computer-measured voltage in individual leads.

This article has been cited by other articles:

				P. Kligfield, L. S. Gettes, J. J. Bailey, R. Childers, B. J. Deal, E. W. Hancock, G. van Herpen, J. A. Kors, P. Macfarlane, D. M. Mirvis, et al. Recommendations for the Standardization and Interpretation of the Electrocardiogram: Part I: The Electrocardiogram and Its Technology A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology J. Am. Coll. Cardiol., March 13, 2007; 49(10): 1109 - 1127. [Abstract] [Full Text] [PDF]

				P. Kligfield, L. S. Gettes, J. J. Bailey, R. Childers, B. J. Deal, E. W. Hancock, G. van Herpen, J. A. Kors, P. Macfarlane, D. M. Mirvis, et al. Recommendations for the Standardization and Interpretation of the Electrocardiogram: Part I: The Electrocardiogram and Its Technology: A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology Circulation, March 13, 2007; 115(10): 1306 - 1324. [Abstract] [Full Text] [PDF]

				P. M. Okin, R. B. Devereux, S. Jern, S. E. Kjeldsen, S. Julius, M. S. Nieminen, S. Snapinn, K. E. Harris, P. Aurup, J. M. Edelman, et al. Regression of Electrocardiographic Left Ventricular Hypertrophy During Antihypertensive Treatment and the Prediction of Major Cardiovascular Events JAMA, November 17, 2004; 292(19): 2343 - 2349. [Abstract] [Full Text] [PDF]

				S. M. Salerno, P. C. Alguire, and H. S. Waxman Competency in Interpretation of 12-Lead Electrocardiograms: A Summary and Appraisal of Published Evidence Ann Intern Med, May 6, 2003; 138(9): 751 - 760. [Abstract] [Full Text] [PDF]