Electrocardiographic detection of left ventricular hypertrophy: Time to forget the Sokolow-Lyon index?

Left ventricular hypertrophy (LVH), detected by standard 12-lead electrocardiogram (ECG) or echocardiography, is a cardinal manifestation of preclinical organ damage related to hypertension, and is a strong predictor of cardiovascular morbidity and mortality in several clinical settings [1]. Regression of ECG or echocardiographic LVH has been shown to occur during long-term effective antihypertensive treatment, and to drive a variety of beneficial effects on left ventricular function, myocardial tissue network, coronary reserve and arrhythmias, thus resulting in an improved cardiovascular prognosis [2]. An ECG is generally considered as the first and mandatory investigation that should be carried out in each hypertensive individual, to detect LVH, ischaemia, conduction abnormalities, left atrial dilatation and arrhythmias - particularly atrial fibrillation; its sensitivity to detect LVH is usually considered to be low (30-50%), while its specificity is high (90%) [3].