To develop improved electrocardiographic criteria of left ventricular hypertrophy, individual electrocardiographic voltage measurements were compared with echocardiographic left ventricular mass in a "learning series" of 414 subjects. The strongest independent relations with left ventricular mass were exhibited by the S wave in lead V3, the R wave in lead a VL and the T wave in lead V1 (each p less than 0.001), and by age and sex. Better electrocardiographic detection of left ventricular hypertrophy was achieved by new criteria that stratified QRS voltage and repolarization findings in sex and age subsets. For men, at all ages, left ventricular hypertrophy is suggested by QRS voltage alone when the R wave in lead aVL and the S wave in lead V3 total more than 35 mm. When this voltage exceeds 22 mm, left ventricular hypertrophy is suggested in men under age 40 years when the T wave in lead V1 is positive (greater than or equal to 0 mm), and in men 40 years or older when the T wave in lead V1 is at least 2 mm. For women, at all ages, left ventricular hypertrophy is suggested when the R wave in lead a VL and the S wave in lead V3 total more than 25 mm. When this voltage exceeds 12 mm, left ventricular hypertrophy is suggested in women under 40 when the T wave in lead V1 is positive (greater than or equal to 0 mm), and in women over 40 when the T wave in lead V1 is 2 mm or greater.(ABSTRACT TRUNCATED AT 250 WORDS)

SUMMARY Experimental studies have suggested that electrocardiographic recognition of left ventricular hypertrophy depends on geometric relationships involving wall thickness and chamber size. To determine the clinical significance of these observations, we studied the effects of echocardiographic LV mass (LVM), posterior wall thickness (PWT), interventricular septal thickness (IVST) and internal dimension (LVID) on THE ECG is a widely used, simple and inexpensive technique, but it is unreliable in the diagnosis of left ventricular hypertrophy (LVH).'-S Progress toward improved ECG recognition of LVH requires identification of the factors that limit current methods. One possible explanation is that conventional voltage and nonvoltage signs of LVH may reflect specific abnormalities of cardiac geometry other than increased LV muscle mass.6In 1956, Brody proposed that the blood within the LV cavity enhances ECG voltage by amplifying radially oriented dipoles.7 In support of this theory, a positive relationship has been found between LV volume and ECG voltage in several experimental studies8'-1 and has been inferred in man on the basis of voltage changes during exercise. However, other studies in patients with chronic heart disease,"2 13 as well as experimental studies of acute changes in LV volume, 14

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