Left Ventricular Hypertrophy : Electrocardiographic Diagnosis

Summary The specificity of diagnostic criteria previously proposed for the diagnosis of left ventricular hypertrophy have been analysed by correlation of the isolated ventricular weight and the twelve‐lead electrocardiogram, and by consideration of commonly associated clinical conditions and of the pathological state of the myocardium in 83 adult hearts. As an aid to the clinical diagnosis of left ventricular hypertrophy in adults over 30 years of age it is concluded of the electrocardiogram: (a) That lesser degrees of left ventricular hypertrophy cannot be accurately diagnosed by any criteria described to date; (b) That, where left ventricular weight exceeds normal by 40%, accurate positive diagnosis can be made in approximately half the cases, and that this proportion increases with the degree of hypertrophy; (c) That only the QRS voltage in the electrocardiogram has any direct relationship to left ventricular weight and is therefore of diagnostic value; (d) That the useful diagnostic criteria may be reduced to two or possibly three: the maximum R+S voltage in the precordial “V” leads; maximal precordial R> 26 millimetres ; R1 + S3> 25 millimetres; (e) That the diagnostic application of relevant QRS voltage criteria is not materially restricted by the administration of digitalis or by the presence of congestive cardiac failure or lesser degrees of ischæmic heart disease. Advanced ischæmic disease involving extensive destruction of the myocardium may reduce QRS voltage and thence its diagnostic value. The term “left ventricular strain” has little meaning, since the electrocardiographic patterns to which it is applied cannot be directly related to left ventricular hypertrophy or to any one physiological, biochemical or dynamic factor recognized at present.