My EKG, Web of the Electrocardiogram Logo

Romhilt-Estes Point Score System

Left Ventricular Hypertrophy

The Romhilt-Estes point score system 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


Voltage criteria: (any of)

R or S in limb leads ≥20 mm

S wave in V1 or V2 ≥30 mm


R wave in V5 or V6 ≥30 mm

ST-T abnormalities

ST-T vector opposite to QRS without digitalis


ST-T vector opposite to QRS with digitalis


Normal ST-T vector


P wave abnormalities

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



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


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


QRS duration ≥0.09 s


Click on "Calculate" button

  • 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.


  • 1. Estes EH, Zhang ZM, et al. The Romhilt-Estes Left Ventricular Hypertrophy Score and Its Components Predict All-Cause Mortality in the General Population. Am Heart J. 2015; 170(1): 104–109. doi: 10.1016/j.ahj.2015.04.004.
  • 2. Romhilt DW, Estes EH Jr. A point-score system for the ECG diagnosis of left ventricular hypertrophy. Am Heart J. 1968; 75: 752-758. doi: 10.1016/0002-8703(68)90035-5.

If you Like it... Share it.