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Background: The ASE/EAE guidelines preferred echocardiographic LV mass in the diagnosis of LVH over linear measurements. Therefore, the amount of discrepancies between the measurements of wall thickness and indexed LV mass lead to uncertainty regarding the diagnosis of LVH.Methods: In 2545 adult outpatients LVH was assessed by measuring LV mass using LV linear dimensions indexed to BSA. The Kappa and Weighted Kappa statistics were used to calculate the strength of the accord in categorizing the presence and severity of LVH of the 2 methods. The percent of agreement was calculated as the ratio between agreed-on measures and the total.Results: 2545 subjects (mean age 62±16, 53% women, mean wall thickness 10.3±2.2 mm and mean indexed LV mass 107.5±37.3 g/m2). 1335 (52.5%) subjects had LVH when the septal thickness was used and 1198 (47.1%) by indexed LV mass. There was a different distribution of LVH severity using septal thickness or indexed LV mass partition values (Fig). Agreement in classifying LVH degree using the 2 methods was met in 1340 and the proportion of overall agreement across the 4 categories was 52.6%. Kappa was 0.29, 95%CI 0.265 to 0.323, p<0.001. Considering the close matches, the weighted Kappa was 0.41. The interclass correlation was 0.52 (95%CI 0.42-0.60, p<0.001). Of the 2513 subjects without severely thickened septum, 472 (18.9%) had severely abnormal indexed LV mass. Vice versa, of the 2045 subjects without severely abnormal indexed LV mass, only 4 (0.1%) were classified as severely LVH by septal thickness. Conclusion: The measurements of indexed LV mass applying the ASE/EAE recommended cutoffs yielded discrepancy in the diagnosis of LVH and the identification of a significant number of patients with LVH that would be missed if classified by wall thickness only criteria.