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There are several criteria used to diagnose LVH via ECG, none 100% accurate though by using multiple criteria sets, the sensitivity and specificity are increased
1.) Romhilt-Estes Criteria (diagnostic>5 points):
R or S limb leads ≥20 mm, or S in V1 or V2 ≥30 mm, or R in V5 or V6 ≥30 mm = 3pt
ST-T vector opposite to QRS without digitalis = 3pt
ST-T vector opposite to QRS with digitalis = 1pt
Negative terminal P mode in V1 1 mm in depth and 0.04 sec in duration = 3pt
Left axis deviation = 2pt
QRS duration ≥0.09 sec = 1pt
Delayed intrinsicoid deflection in V5 or V6 (>0.05 sec) = 1pt
2.) Cornell Criteria:
S in V3 + R in aVL > 28 mm (men)
S in V3 + R in aVL > 20 mm (women)
3.) Sokolow-Lyon Criteria:
S in V1 + R in V5 or V6 ≥ 35 mm
R in aVL ≥ 11 mms
References
Okin PM, Roman MJ, Devereux RB, Kligfield P. Electrocardiographic identification of increased left ventricular mass by simple voltage-duration products. J Am Coll Cardiol. 1995 Feb; 25(2):417-23.