The electrocardiographic recognition of left ventricular hypertrophy

Abstract

This study correlated the cardiac findings at autopsy with electrocardiograms and teleoroentgenograms of 135 patients with left ventricular hypertrophy. Tracings and chest x-ray films from 71 patients without anatomic evidence of cardiac hypertrophy served as a control group. The reliability of the chest film, as well as the sensitivity and specificity of the set of 11 electrocardiographic criteria for LVH enumerated by Sokolow and Lyon were evaluated and compared. Reasons for selecting these criteria are discussed. The electrocardiogram is generally a more adequate means for the detection of LVH than is the chest x-ray film. The more sensitive but least specific indicators of LVH appear to be RS-T-segment depression and T-wave abnormalities. These are also the criteria most influenced by the presence of digitalization and infarction. Increased amplitude of QRS is more specific, and much less sensitive, an indicator of LVH and does not appear to be influenced by associated digitalization or infarction. The most specific criterion of LVH is prolongation of the ventricular activation time, but it is so insensitive as to be of limited value. Possible mechanisms for the genesis of the electrocardiographic changes in left ventricular hypertrophy are discussed.