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Purpose: Left ventricular hypertrophy (LVH) is a powerful independent predictor of cardiovascular morbidity and mortality irrespective of aetiology. Left ventricular wall thickness and mass have been correlated with QRS voltage in the 12-lead electrocardiogram (ECG). Although echocardiogram (echo) is a powerful tool to identify LVH, the ECG remains the cornerstone of LVH diagnosis in clinical practice. The aim of this study was to investigate if there is a racial difference in the estimation of LVH by using the ECG voltage criteria of Sokolow- Lyon and Cornell.Methods: A total of 104 consecutive patients (Caucasian (CAU) =40, Afro-Caribbean (AF-C) = 36 and Indo-Asian (IN-A) = 28) attending our one-stop cardiology clinic for various cardiological reasons within nine months were retrospectively studied. All patients underwent resting ECG and echo. Left ventricular mass index (LVMI) was calculated from echo by conventional techniquesResults: A significantly higher rate of LVH (44%) was found in the AF-C compared to 12.5% in the Caucasian and 14% in the IN-A. The sensitivity and specificity of the Sokolow-Lyon criteria to diagnose LVH were 52% and 92% respectively while those of the Cornell criteria were 68% and 91%). The results of cross-correlation between ECG-identified LVH and that identified by echo using chi square analysis are shown in Table. Whereas the Cornell criterion predicted echo-determined LVH in all the three ethnic groups, the Sokolow-Lyon ECG LVH criterion predicted LVH in the Caucasian and the Indo-Asian population but not in the Afro-Caribbean.Conclusion: Ethnic differences in the ECG-predicted LVH using the ECG voltage criteria of Sokolow-Lyon do exist and need to be recognised to avoid failure to diagnose LVH by ECG in subjects of Afro-Caribbean origin.