Detection of left ventricular hypertrophy (LVH) with electrocardiographic Sokolow-Lyon or Cornell voltage criteria was found to predict stroke and improve risk stratification among patients with hypertension, according to a meta-analysis published in the Journal of Electrocardiology.

Literature databases were quarried up to September 1, 2019. Studies evaluating the risk for stroke with determination of electrocardiographic LVH at baseline using Sokolow-Lyon voltage, Cornell voltage, or Cornell product criteria in patients with hypertension, were included. In total, 215 potential studies were reviewed. Most articles (n=186) were removed due to inadequate study design or for other unspecified reasons (n=22). A total of 7 studies of 58,098 patients were included.

Of the included articles, 4 and 3 were prospective and retrospective studies published in 2001 or after, respectively. The study sample sizes varied between 552 and 26,384 participants. The patients were aged between 51.6 to 83.5 years. Follow-up times ranged from 2.1 to 15 years. A total of 5 studies were considered to be of high quality by the authors of the meta-analysis.

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In patients with vs without electrocardiographic LVH, the risk ratio (RR) of having a stroke was 1.63 (95% CI, 1.38-1.93; P =.102) for Cornell voltage, 1.42 (95% CI, 1.20-1.69; P =.255) for Sokolow-Lyon voltage, and 1.41 (95% CI, 1.07-1.86; P =.346) for Cornell product criteria.

In a sensitivity analysis which was performed by removing individual studies and recalculating RRs, those varied for Cornell voltage criteria between 1.41 and1.71, and between 1.37 and 1.51 for Sokolow-Lyon voltage criteria. The variance observed for the Cornell product criteria had a low 95% CI (0.94-1.12), leading the investigators to determine this criterion as unreliable for stroke prediction.

No evidence of publication bias were observed, based on the Begg’s test (P =1.000 and P =.308) or the Egger’s test (P =.911 and P =.408) for either the Sokolow-Lyon or Cornell voltage criteria, respectively. No publication bias tests were reported for the Cornell product criteria.

This study has 3 major limitations: Use of antihypertensive drugs may have reduced the estimation of stroke risk at baseline; the small number of included studies precluded subgroup analyses of gender or ethnicity; the meta-analysis focused on the 3 major electrocardiographic criteria, and it remains unclear whether the other >30 methods may have a higher predictive power.

“This meta-analysis provides evidence that baseline electrocardiographic LVH detecting by Sokolow-Lyon and Cornell voltage criteria predicts the development of stroke in hypertensive patients, even after adjustment for conventional risk factors,” concluded the study authors. “Use of electrocardiographic LVH has potential to improve stroke risk stratification in hypertensive patients.”


Yi S, Wang F, Wan M, et al. Prediction of stroke with electrocardiographic left ventricular hypertrophy in hypertensive patients: a meta-analysis. J Electrocard. 2020;61:27-31. doi:10.1016/j.jelectrocard.2020.04.018

This article originally appeared on The Cardiology Advisor