Abstract
It is correctly stated that ECG is not very informative in cases of left ventricular hypertrophy (LVH) due to essential hypertension because of its low sensitivity for this condition. The large number of indices does nothing to alter this fact. Unfortunately, the authors do not offer us any judgment about another scientific technique that is directly based on the ECG, namely, the measurement of heart-rate variability (HRV). There is a great deal of evidence supporting the hypothesis that LVH is associated, as a risk factor, with elevation of sympathetic tone (very low frequency [VLF] in spectral analysis) and with reduced heart-rate variability (reduction of the coefficient of variation [CV] and of the standard deviation of normal-to-normal intervals [SDNN]), i.e., with a tendency for the heart rate to remain constant. The greater this tendency, the worse the prognosis with regard to survival. Unfortunately, despite the good evidence that LVH is useful, it is little known in Germany, while ECG remains highly popular (and perhaps excessively so).
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