Geometric determinants of electrocardiographic left ventricular hypertrophy.

Abstract

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

The Relationship Between R Amplitude in Lead V₅ (RV₅) and Left Ventricular Mass in the Groups of Adolescent Subjects Classified by Body Composition

“…In the reports on the LV mass of young adults (19-24-year-old non-athletes), the LV mass ranges from 135 to 197 g in males and from 123 to 128 g in females. [31][32][33][34][35][36][37][38] In the present study, the LV mass in boys (174.4±14.0 g) is almost equal to the results of those previous studies, but in girls the mean value of LV mass (157.4±11.1 g) is somewhat higher than that already presented. Devereux …”

“…Moreover, the low %fat in male subjects (40-50% less than in female) is well known and the %fat values obtained by us have been proven through our previous work not to be so different from other data presented in past reports using the same measurement method as ours. 29 The LV mass of boys has also been reported to be larger than that of girls, 30,31 but as far as we know the normal range of LV mass has not presented for adolescents, including 15-year-olds. In the reports on the LV mass of young adults (19-24-year-old non-athletes), the LV mass ranges from 135 to 197 g in males and from 123 to 128 g in females.…”

Electrocardiogram for the Diagnosis of Right Ventricular Hypertrophy and Dilation in Idiopathic Pulmonary Arterial Hypertension

“…21 In contrast, Devereux et al found that ECG voltage criteria are independent of left ventricular chamber dilatation. 22 To date, the results of such analysis for the RV has not been available. Data from our study suggest a dominant role of RVH, but not dilation, in determining the ECG voltage criteria.…”

Effect of Obesity on Electrocardiographic Left Ventricular Hypertrophy in Hypertensive Patients

“…However, low sensitivity of standard voltage criteria for detection of LV hypertrophy (LVH) has limited utility of the ECG for identification of patients with LVH. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Although Cornell voltage criteria modestly improve ECG detection of LVH in hypertensive patients, 6,7 the product of Cornell voltage and QRS duration (Cornell voltage-duration product), 8,9 an approximation of the area under the QRS, 10 appears to further enhance sensitivity of the ECG for LVH while maintaining high specificity. As a consequence, Cornell voltage-duration product criteria were used in combination with SokolowLyon voltage 5 to identify hypertensive patients at increased risk of subsequent cardiovascular morbidity and mortality for inclusion in the Losartan Intervention For Endpoint (LIFE) Reduction in Hypertension Study, a prospective trial designed to compare the efficacy of losartan and atenolol in reducing the risk of cardiovascular events.…”