Abstract
Objective: Left ventricular hypertrophy (LVH) is an important marker of cardiovascular morbidity and mortality. Although echocardiography is the diagnostic standard, its limited availability in many Asian settings—including Vietnam—necessitates simple and accessible screening tools. Classical electrocardiographic (ECG) voltage criteria have shown modest diagnostic accuracy in Asian populations. This study aimed to evaluate the diagnostic performance of three established ECG criteria and develop a pragmatic clinical–electrocardiographic model for predicting LVH in Vietnamese patients. Methods: We conducted a cross-sectional retrospective study of 1,026 adults who underwent both transthoracic echocardiography and 12-lead ECG during the same clinical encounter at Tam Anh Hospital from September to December 2023. LVH was defined by LV mass index ≥116 g/m² in men or ≥96 g/m² in women. ECG voltages were measured according to Sokolow–Lyon, Cornell, and Peguero–Lo Presti criteria. Diagnostic accuracy was assessed using sensitivity, specificity, predictive values, and area under the receiver operating characteristic curve (AUC). Multivariable logistic regression was used to identify independent predictors and develop a point-based LVH prediction model. Results: Classical ECG criteria demonstrated limited diagnostic performance, with AUC values of 0.561 (Sokolow–Lyon), 0.587 (Cornell), and 0.609 (Peguero–Lo Presti). Multivariable analysis identified five independent predictors of LVH: age ≥65 years, female sex, hypertension, heart failure, and a positive Sokolow–Lyon index. The resulting five-factor scoring model achieved an AUC of 0.805, with sensitivity 79.4% and specificity 67.4% at the optimal cutoff. Conclusion: In the Vietnamese population, ECG voltage criteria alone show modest diagnostic accuracy for LVH. Integrating key clinical characteristics with ECG findings significantly improves prediction performance. The proposed model provides a simple, feasible, and resource-appropriate tool for LVH screening in settings with limited access to echocardiography.
