Validity of Electrocardiographic Voltage Criteria: How Useful Are They in Athletes?

Electrocardiographic (ECG) criteria for left ventricular (LV) hypertrophy have been almost exclusively elaborated and calibrated in general population. Because several differences in ECG characteristics have been found in athletes, the applicability of these criteria to athletes individuals remains to be demonstrated. We therefore investigated the performance of classic ECG criteria (Sokolow-Lyon voltage criterion) for detection of LV hypertrophy in professional athletes. We compared ECG patterns with cardiac morphology (as assessed by echocardiography) in 90 athletes (aged 23.4+4.3 years). we found that, the value of Sokolow-Lyon voltage criterion in athletes ranged from 18 to 53 mm (mean, 34.7+8 mm), and about 56% of them had Left ventricular hypertrophy according to this criterion. The sensitivity of ECG to detect correctly the presence of ventricular hypertrophy in athletes is low (63.6%) which means that the ECG missed 36.4% of cases of left ventricular hypertrophy. On the other hand, the ECG ability to exclude ventricular hypertrophy among athletes without such condition (specificity) was very low (50.9%). So that, caution should be taken when using ECG voltage criteria for LV hypertrophy detection in athletes because they exhibit only limited accuracy (generally due to poor sensitivity and specificity).