Sokolow-Lyon and Cornell LVH Criteria Calculator
Sokolow-Lyon and Cornell LVH Criteria Calculator
Score one ECG against three published voltage criteria for left ventricular hypertrophy at once — Sokolow-Lyon, Cornell voltage and the Cornell voltage-duration product — with the sensitivity each achieved and against what standard.
Cornell product, with Sokolow-Lyon and Cornell voltage
3 criteria, 1 ECGMale; S in V1 14 mm, R in V5 24 mm, R in aVL 12 mm, S in V3 18 mm, QRS 96 ms
The three criteria
Cornell voltage RaVL + SV3 > 28 mm (men), > 20 mm (women)
Cornell product (RaVL + SV3 + 8 mm in women) × QRS > 2440 mm·ms
- Sokolow-Lyon, 1949
- S in V1 plus the taller R wave of V5 and V6, at 35 mm. Against modern echocardiography it performs badly: 9% sensitivity, 86% specificity and an area under the curve of 0.44 in a 95-patient series
- Cornell voltage, 1987
- R in aVL plus S in V3, thresholds 28 mm in men and 20 mm in women, validated against autopsy in 135 patients: 42% sensitivity at 96% specificity. Using aVL rather than the precordial leads makes it less sensitive to chest wall thickness
- the product, and the 8 mm in women
- hypertrophied myocardium conducts more slowly as well as generating more voltage, so duration carries information amplitude does not. The product uses one threshold for both sexes and absorbs the sex difference by adding 8 mm to the voltage sum in women BEFORE multiplying — that is how the criterion is defined, not an adjustment to the measurement
- specific, not sensitive
- all three were built to avoid false positives and all three miss most hypertrophy. Nothing here excludes left ventricular hypertrophy, and every threshold assumes the standard 10 mm per millivolt calibration
Worked example
Male; S in V1 14 mm, R in V5 24 mm, R in aVL 12 mm, S in V3 18 mm, QRS 96 ms
Cornell voltage = 12 + 18 = 30 mm, above the 28 mm male threshold
Cornell product = 30 × 96 = 2,880 mm·ms, above the 2,440 threshold
Sokolow-Lyon = 14 + 24 = 38 mm, above its 35 mm threshold
All three are met, which is the most informative result they can produce — the three disagree far more often than they agree, because they are built from different leads
Set the sex to female and the product becomes (30 + 8) × 96 = 3,648 mm·ms while the voltage threshold falls from 28 mm to 20 mm: the same trace is further past both Cornell criteria in a woman
Drop the R wave in aVL to 8 mm: Cornell voltage becomes 26 mm, under the male threshold, while the product is 2,496 mm·ms, still over 2,440. The two Cornell criteria can disagree on one trace, and the product is the more sensitive
The three criteria, their sources and what they achieved
| Criterion | Threshold | Reference standard and cohort | Performance |
|---|---|---|---|
| Sokolow-Lyon | S in V1 plus R in V5 or V6, 35 mm or more | Presumed hypertrophy, 147 patients against 151 controls (Sokolow and Lyon, Am Heart J 1949) | Reached 35 mm in 48 of 147 patients and in none of the controls — high specificity, low sensitivity |
| Cornell voltage | R in aVL plus S in V3, over 28 mm in men and over 20 mm in women | Autopsy left ventricular mass, 135 patients (Casale et al, Circulation 1987) | 42% sensitivity, 96% specificity |
| Cornell voltage-duration product | (R in aVL plus S in V3, plus 8 mm in women) × QRS, over 2,440 mm·ms | Autopsy, 220 patients of whom 95 had anatomical hypertrophy (Molloy et al, J Am Coll Cardiol 1992) | Sensitivity rose from 36% for Cornell voltage to 51% for the product at a fixed 95% specificity |
| Peguero-Lo Presti (not computed here) | Deepest S in any lead plus S in V4, 28 mm or more in men and 23 mm or more in women | 216 patients across combined cohorts (Peguero et al, J Am Coll Cardiol 2017) | 62% sensitivity and 90% specificity overall, falling to 57% sensitivity in the 122-patient validation subset |
Head to head against echocardiographic mass index in one cohort
| Criterion | Sensitivity | Specificity | Area under the curve |
|---|---|---|---|
| Sokolow-Lyon | 9.4% | 85.7% | 0.44 |
| R in aVL alone, 11 mm or more | 6.3% | 90.5% | 0.51 |
| Cornell voltage | 21.9% | 100% | 0.69 |
| Cornell product | 31.3% | 95.2% | 0.72 |
| Peguero-Lo Presti | 31.3% | 85.7% | 0.68 |
Built to be specific, and insensitive by design
Every ECG criterion for left ventricular hypertrophy infers muscle mass from the voltage that reaches the skin, and everything between the two degrades the inference: chest wall thickness, lung volume, pericardial fluid, the position of the heart in the chest and of the electrodes on it. Sokolow and Lyon’s 1949 criterion adds the S wave in V1 to the taller of the R waves in V5 and V6 and calls 35 mm positive. The Cornell criteria use R in aVL plus S in V3 with sex-specific thresholds, which is less affected by habitus because aVL is a limb lead. The Cornell product multiplies that sum by the QRS duration, on the reasoning that hypertrophied myocardium conducts more slowly as well as generating more voltage.
All three were built for specificity and all three are insensitive. Against autopsy mass in 135 patients, Cornell voltage achieved 42% sensitivity at 96% specificity. The product, in 220 autopsy patients, raised sensitivity from 36% to 51% at a fixed 95% specificity. Measured against echocardiographic mass index in a 95-patient cohort the numbers fall further — 31% for the product, 22% for Cornell voltage and 9% for Sokolow-Lyon, whose area under the curve was 0.44, below chance. The drop is not a contradiction: an echocardiographic mass index identifies much more mild hypertrophy than autopsy did, so the same criterion has more to miss.
The practical consequence is asymmetric and worth stating plainly. A positive criterion, particularly more than one at once, is reasonably specific. A negative ECG means almost nothing: between half and nine-tenths of hypertrophied ventricles do not meet these thresholds, so an ECG cannot exclude hypertrophy in a hypertensive patient there is a reason to worry about. That question belongs to imaging, and the left ventricular mass index measured by echocardiography is the measurement these criteria are trying and failing to approximate.
Three technical traps. The thresholds assume the standard calibration of 10 mm per millivolt, so a trace at half standard fails all of them mechanically. None of the criteria was derived in bundle branch block, and left bundle branch block generates large precordial voltages of its own that have nothing to do with mass — the Cornell product is worst affected, because the QRS duration it multiplies by is precisely what the block has changed. And the product’s 8 mm addition in women is part of the published criterion rather than an adjustment to the measurement, so it belongs inside the multiplication and not outside it. This supports a clinician’s judgement rather than replacing it.
Frequently asked questions
What are the Sokolow-Lyon criteria for LVH?
The S wave in V1 plus the taller R wave of V5 and V6, at 35 mm or more at standard calibration. In the original 1949 series the sum reached 35 mm in 48 of 147 patients with presumed hypertrophy and in none of 151 controls; against echocardiography it reached 9% sensitivity in one 95-patient series.
What is the Cornell voltage criterion?
R in aVL plus S in V3, with sex-specific thresholds of over 28 mm in men and over 20 mm in women. Validated against autopsy left ventricular mass in 135 patients: 42% sensitivity at 96% specificity.
What is the Cornell voltage-duration product?
The Cornell voltage sum, with 8 mm added in women, times the QRS duration in milliseconds, threshold 2,440 mm·ms. In 220 autopsy patients it raised sensitivity from 36% to 51% at a fixed 95% specificity, making it the most sensitive of the three computed here.
Can an ECG rule out left ventricular hypertrophy?
No. These criteria were built for specificity and miss between half and nine-tenths of hypertrophied ventricles depending on the reference standard. A negative ECG is a reason to image, not a reassurance; echocardiographic mass index is the measurement the ECG is approximating.
Do these criteria work in bundle branch block?
They were not derived in it and should not be applied to it. Left bundle branch block produces large precordial voltages of its own, unrelated to muscle mass, and the Cornell product is worst affected because the QRS duration it multiplies by is exactly what the block changed.
Related calculators
References
- Sokolow M, Lyon TP. The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J. 1949;37(2):161–186.
- Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P. Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings. Circulation. 1987;75(3):565–572.
- Molloy TJ, Okin PM, Devereux RB, Kligfield P. Electrocardiographic detection of left ventricular hypertrophy by the simple QRS voltage-duration product. J Am Coll Cardiol. 1992;20(5):1180–1186.
- Peguero JG, Lo Presti S, Perez J, Issa O, Brenes JC, Tolentino A. Electrocardiographic criteria for the diagnosis of left ventricular hypertrophy. J Am Coll Cardiol. 2017;69(13):1694–1703.
- Comparison of electrocardiographic criteria for left ventricular hypertrophy against echocardiographic myocardial mass index in 95 patients. Acta Medica Lituanica. 2022. Accessed via journals.vu.lt, October 2026.
Not medical advice. For healthcare professionals and education. Reference intervals vary by laboratory and assay — always use your own laboratory's. Never base a dose or a treatment decision on this page alone. Full disclaimer at calcengines.com/disclaimer/