ST-segment elevation(STE)was an important but neglected sign in patients with electrocardio-graphic left ventricular high voltage(LVHV),which might lead to a mistaken diagnosis of ST-segment elevation myocardial infarction(STEMI).The aim of this study was to investigate risk factors associated with STE in pa-tients with LVHV.Methods A total of 1,590 inpatients(including 81 cases with ST-segment elevation and 1509 cases with non-ST segment elevation)with electrocardiographic LVHV without confounding factors(such as myocardial infarction)were enrolled in this study.The 81 ST-segment elevation(STE)cases were assigned to the STE group while 87 out of the 1509 non-ST segment elevation(non-STE)cases were randomly selected and assigned to the non-STE group.Data on potential risk factors and patients\'characteristics were collected.Logis-tic regression analysis and receiver operating characteristic curve(ROC)were used to identify the risk of STE in patients with LVHV.Results The mean age of the 168 studied cohort(119 males,70.83％)was 62.33±16.27 years.The two groups did not differ with regard to gender(male)and age(P=0.420 and P=0.795,respectively).Multivariate analysis showed that stroke,infection,and the value of Sv1+Rv5 were significantly associated with STE secondary to LVHV.The area under the curve(AUC)showed that the optimal value of Sv1+Rv5 cut-off for predicting STE in patients with LVHV was 4.805(sensitivity:40.74％,specificity:80.46％,AUC:0.634,95％CI:0.550-0.719,P＜0.05).Conclusions A value of Sv1+Rv5 more than 4.8 mV,stroke,and infection are indepen-dent risk factors associated with non-ischemic STE in patients with electrocardiographic LVHV.