Circulation, Vol 63, 1391-1398, Copyright © 1981 by American Heart Association
N Reichek and RB Devereux
Anatomic, echocardiographic and ECG findings of left ventricular
hypertrophy (LVH) were compared in 34 subjects. Echocardiographic LV mass
correlated weel with postmortem LV weight (r = 0.96) and accurately
diagnosed LVH (sensitivity 93%, specificity 95%). In contrast,
Romhilt-Estes (RE) point score and Sokolow-Lyon (SL) voltage criteria for
ECG LVH were insensitive (50% and 21%, respectively) but specific (both
95%). RE correlated weakly with LV weight (r = 0.64), but SL did not.
Echocardiographic LV mass was then compared with RE and SL in an unselected
clinical series of 100 subjects, in 28 subjects with severe aortic stenosis
(AS) and in 14 with severe aortic regurgitation (AR). Results in the
clinical series were comparable to those in the necropsy series. In the AS
and AR groups, with a high prevalence of LVH, the low sensitivity of RE
point score and Sl criteria led to poor overall results. Analysis of
individual ECG variables showed that most voltage information is contained
in leads aVL and V1. Correction of voltage for distance from the left
ventricle did not substantially improve results. Individual nonvoltage
criteria were each nearly as sensitive as RE point score. We could not
devise new ECG criteria that improved diagnostic results. We conclude that
the ECG is specific but insensitive in recognition of LVH. Moreover, when
true LVH prevalence is less than 10%, more false-positive than true-
positive diagnoses will be obtained. M-mode echocardiographic LV mass is
superior to ECG criteria for clinical diagnosis of LVH.
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Left ventricular hypertrophy: relationship of anatomic, echocardiographic and electrocardiographic findings
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