In 1968, Romhilt and Estes (R&E) described the point score system shown here. It also gives primary weight to R and S wave voltage criteria. In addition, it considers T wave and QRS axes, P wave changes suggestive of left atrial abnormalities and QRS duration. A point score greater than 4 was considered suggestive of left ventricular hypertrophy and a score greater that 5 indicated a high likelihood of this diagnosis.