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Recent Journal Updates

CancerJun 5, 2026

Executive summary of American Radium Society Appropriate Use Criteria for the treatment of locoregionally recurrent rectal cancer

Clinical Context

We think this might be relevant to the clinical guidance for Cornell Voltage Criteria (Left Ventricular Hypertrophy).

DiabetologiaMay 26, 2026

Clinical and psychological phenotypes of type 1 diabetes and disordered eating derived from a case vignette series: T1DE phenotypes

Clinical Context

We think this might be relevant to the clinical guidance for Cornell Voltage Criteria (Left Ventricular Hypertrophy).

DiabetologiaMay 22, 2026

Clinical Context

We think this might be relevant to the clinical guidance for Cornell Voltage Criteria (Left Ventricular Hypertrophy).

Cornell Voltage Criteria

Cornell LVH

Standard Voltage Analysis for LVH

Baseline Reference (Sex)

R wave in aVL

S wave in V3

Enhanced Sensitivity (Cornell Product)

The Cornell Criteria is highly reliable for specificity. However, if the sum is borderline, check for the "RaVL Criterion" (R in aVL > 11 mm) or signs of Left Atrial Enlargement.

Input EKG leads
to analyze LVH

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

Primary Indications

ECG screening for left ventricular hypertrophy (LVH) – Non-invasive, widely available, low-cost initial test

Chronic hypertension monitoring – Assess target organ damage from long-standing or poorly controlled hypertension

Risk stratification in hypertensive patients – LVH by ECG predicts increased cardiovascular morbidity and mortality (2-4x higher risk of MI, stroke, heart failure, sudden cardiac death)

Sex-specific assessment – Superior sensitivity in women compared to Sokolow-Lyon (Cornell: 42% vs Sokolow-Lyon: 23% sensitivity at 95% specificity)

Screening for hypertrophic cardiomyopathy (HCM) – When combined with clinical suspicion and family history

Aortic stenosis severity assessment – LVH is an adaptive response to pressure overload; absence of LVH in severe AS suggests alternate diagnosis

Athlete vs pathology differentiation – Physiologic LVH in athletes (increased voltage with normal LV dimensions, no ST/T changes) vs pathologic LVH (with repolarization abnormalities)

Prognostic stratification post-MI – Regression of LVH with ACE inhibitors/ARBs predicts improved outcomes

Contraindications / Limitations

Left bundle branch block (LBBB) – Voltage criteria unreliable; rely on LBBB-specific LVH criteria (e.g., Sclarovsky-Birnbaum)

Ventricular paced rhythms – Artificial depolarization alters voltage distribution

Left anterior fascicular block (LAFB) – Alters frontal plane voltages; caution with interpretation

Poor ECG quality – Baseline wander, muscle artifact, improper lead placement invalidate measurements

Low voltage ECG – Obese patients, COPD, pericardial effusion, amyloidosis (Cornell will underdiagnose LVH)

Athletes with physiologic LVH – High voltage may be normal; requires clinical correlation (ST/T wave abnormalities suggest pathology)

NOT a substitute for echocardiography – ECG LVH criteria have modest sensitivity (30-50%) but high specificity (85-95%). Echo (LV mass index) is gold standard for LVH diagnosis.

Comparison of LVH ECG Criteria

Criterion	Formula	Threshold (LVH Present)	Sensitivity (Echo-proven LVH)	Specificity	Best For
Cornell Voltage (original, 1991)	RaVL + SV3	Men: >20 mm Women: >28 mm	40-50%	90-95%	Women (far better sensitivity than Sokolow-Lyon). General screening.
Cornell Product (1991)	(RaVL + SV3) × QRS duration (ms)	>2440 mm·ms	45-55%	90-95%	Added accuracy when QRS is prolonged (intraventricular conduction delay)
Sokolow-Lyon (1949)	SV1 + RV5 or RV6 (whichever larger)	≥35 mm	35-45%	85-90%	Men (historically derived from young men). Simpler to calculate.
Romhilt-Estes (1968)	Point score system - Voltage criteria: 3 points - ST/T changes: 3 points - Left atrial enlargement: 3 points - Left axis deviation: 2 points - QRS duration >90ms: 1 point - Intrinsicoid deflection >50ms: 1 point	≥5 points = definite LVH 4 points = probable LVH	30-40%	95-98%	Highest specificity for autopsy-proven LVH (point score system)
Peguero-Lo Presti (2017)	Deepest S wave in any lead (V1-V6) + SV4	Men: >28 mm Women: >23 mm	55-65%	85-90%	Obesity, COPD (where QRS voltages are generally lower)
Framingham (1990)	SV1 + RV5/V6 or RaVL + SV3 (sex-specific continuous score)	Sex-specific percentile-based (e.g., >95th percentile)	Variable (depends on percentile)	Variable	Research settings, not commonly used clinically

Related Scores in Practice

In clinical practice, this assessment is frequently evaluated alongside other validated measures. Depending on the patient's presentation and specific diagnostic requirements, you may also need to utilize the Sokolow-Lyon Voltage, LV Mass Index, Bazett Qtc or the Framingham Risk Score to formulate a comprehensive care plan.

Last Comprehensive Review: 2026