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Romhilt-Estes Score

Left Ventricular Hypertrophy


The Romhilt-Estes Score was one of the early efforts to improve the ability of the Electrocardiogram to detect Left Ventricular Hypertrophy (LVH). This score was developed before any imaging technologies were available 1.

The Romhilt-Estes Score assigned points for the presence of each of six EKG features. If a given EKG reached a total of 5 points, it was considered positive for LVH, and 4 points were considered as probable LVH.

The point score system proved to be more specific in predicting Left Ventricular Hypertrophy than previous systems, but the sensitivity was low, in the range of 60% in the original series, similar to other EKG LVH criteria as the Sokolow-Lyon index or the Cornell voltage criteria 2.

Romhilt-Estes Score

Points

Voltage Criteria: (any of)

R or S in limb leads ≥ 20 mm

S wave in V1 or V2 ≥ 30 mm

3

R wave in V5 or V6 ≥ 30 mm

ST-T abnormalities

ST-T vector opposite to QRS without digitalis

3

ST-T vector opposite to QRS with digitalis

1

Normal ST-T vector

0

P wave abnormalities

Negative terminal P mode in V1 ≥ 1 mm in depth or 40 ms in duration

3

Others

Left axis deviation (QRS of -30° or more)

2

Delayed intrinsicoid deflection in V5 or V6 (> 0.05 s)

1

QRS duration ≥ 0.09 s

1

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  • Romhilt-Estes Point Score System

  • 3 points or less: No signs of Left Ventricular Hypertrophy.
  • 4 points: Probable Left Ventricular Hypertrophy.
  • 5 or more points: Positive for Left Ventricular Hypertrophy 2.

References

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