Limitations of the Electrocardiographic Diagnosis of Ventricular Hypertrophy

Electrocardiography provides the clinician with an important tool, permitting the diagnosis of hypertrophy of either or both cardiac ventricles. Such information is of particular importance in patients with chronic cardiac overload, in whom the severity and the stage of the disease can be estimated. Thus, in systemic or pulmonary hypertension, in aortic or pulmonary stenosis, and in many other cardiac lesions, the development of ventricular hypertrophy indicates a serious degree of increased cardiac workload and often provides a reason for more agressive therapy. In the clinical application of electrocardiography, the clinician is encouraged by many writings crediting this procedure with extraordinary accuracy, up to a point of predicting the hemodynamic status of the patient from the tracing. It is often overlooked, however, that the bases for such claims are statistical correlations, which, as in all biological relationships, apply more to groups of cases than to individual examples. The unavoidable scatter