Novel electrocardiographic diagnosis of left ventricular hypertrophy with right bundle branch block in a Taiwanese clinical cohort

BACKGROUND The diagnostic accuracy of electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) in Taiwanese adults remains uncertain, particularly in the presence of complete right bundle branch block (CRBBB). METHODS We retrospectively enrolled 431 Taiwanese adults, including 205 with normal conduction and 226 with CRBBB. Echocardiographic left ventricular mass index (LVMI) served as the reference standard. We evaluated the sensitivity, specificity and area under the receiver operating characteristic curve (AUC) of six traditional ECG criteria: Sokolow-Lyon index, RaVL, modified Sokolow-Lyon, Cornell voltage, Gubner-Ungerleider and Peguero-Lo Presti. Linear regression examined associations between individual ECG parameters and LVMI, with a focus on the impact of CRBBB. Exploratory analyses were conducted to derive novel ECG indices. RESULTS Traditional ECG criteria showed low sensitivity but high specificity overall. In patients with normal conduction, Cornell voltage performed best in females and Gubner-Ungerleider in males. However, diagnostic performance decreased substantially in the presence of CRBBB, particularly for criteria relying on anteroseptal leads. In CRBBB patients, QRS duration demonstrated stronger correlation with LVMI than voltage-based criteria. In our cohort, ECG criteria with superior performance is SD× QRS (AUC 0.754) in males with CRBBB, QRS duration (AUC 0.868) in CRBBB females and BMI<24, and SV4 amplitude (AUC 0.702) in CRBBB females with BMI≥ 24. CONCLUSION Traditional ECG criteria for LVH originally developed in Western cohorts demonstrated limited diagnostic performance in Taiwanese adults, particularly in the setting of CRBBB. QRS duration and derived indices may provide more accurate alternatives for detecting LVH in this population.