Correlative study between electrocardiographic findings and ventricular wall thickness based on cardio-synchronous angiocardiography. II. Study of electrocardiographic criteria for ventricular hypertrophy.

Abstract

In order to evaluate the accuracy of the electrocardiographic criteria for the diagnosis of ventricular hypertrophy, end-diastolic angiocardiograms in left anterior oblique projection were performed in 152 patients from 18 to 65 years of age. The correlation between the ventricular wall thickness measured on 12×10 films and electrocardiographic findings were examined. Angiocardiographic analysis with regard to the ventricular wall thickness revealed 38 cases of LVH, 24 cases of RVH, 16 cases of CVH and 65 cases of normal thickness of both ventricular walls. The positivity and the false positivity by the criteria for LVH used were found to be 92.1 per cent and 53.8 per cent, respectively. "Rv5(6)+Sv1≥35(40)mm" was more satisfactory than "Rv5(6)+Sv1≥35mm" (68.4 per cent of positivity with 18.5 per cent of false positives for the former and 71.1 per cent of positivity with 35.4 per cent of false positives for the latter). High voltage in the extremity leads appeared to be of less value in the diagnosis of LVH. MORI's criteria, except "ΣLVP≥40(50)mm", had a lower incidence of false positives than SOKOLOW and LYON's voltage criteria on chest electrocardiogram. Pattern criteria of KIMURA gave the highest positivity when the presence of "one or more" of three conditions was accepted as satisfactory criteria for LVH, whereas it gave the lowest incidence of false positives with the fewest positive correlation when the presence of "two or more" of three conditions was applied. KATO's set of the criteria was found to be the most sensitive in the diagnosis of LVH, although each item itself was not so high diagnostic value. Finally it was concluded that the single criterion, whichever the voltage or the pattern criterion, was not satisfactory enough for the diagnosis of LVH, but the set of the two conditions appeared to be more useful. Herein proposed is the set of "Rv5(6)+Sv1≥40(45)mm" (45mm is used for persons of 25 years old or younger) and the pattern of "SIII>sII" as a diagnostic criteria for screening examination of LVH (90 per cent of positivity). And when the presence of "Rv5(6)+Sv1>≥40(45)mm" with "SIII>SII" or with "comparative ratio of R and S on chest leads over 10" was used as the criteria for LVH, it gave only 1.5 per cent of false positives with 50.0 per cent of positive correlation. This set of the criteria is useful to confirm the presence of LVH. The electrocardiographic diagnosis of RVH was made in 52.6 per cent by the criteria used in this study. The positive correlation was influenced by the ratio of the left ventricular wall thickness to that of the right. The positive correlation was found more frequently in RVH due to congenital heart disease than in RVH due to acquired heart disease. Among the various criteria for RVH, R/S ratio in V1 over 1.0 and R/S in Lead I less than 1.0 may be concluded to be sensitive and RAD>110 degrees and RaVR≥5.0mm were found fairly to be specific. The significance of rSR' pattern in the right precordial leads with a normal QRS duration was briefly discussed. Poor reliability of electrocardiography was observed on the diagnosis of CVH (6.3 per cent of established diagnosis). It is notable fact that 8 of 16 patients who showed angiocardiographic evidence of CVH had hypertensive heart disease. The ratio of the left ventricular wall thickness to that of the right appeared to influence the incidence of positivity but no close relationship between them was obtained. MORI's criteria gave higher percentages in the positive correlation with CVH than that with LVH.