Circulation, Vol 60, 386-396, Copyright © 1979 by American Heart Association
EM Antman, LH Green and W Grossman
The relative importance of left ventricular (LV) geometry, wall thickness,
and mass on the inscription of left ventricular hypertrophy (LVH) on the
ECG was examined in 93 patients; 36 had no LVH on the ECG, 10 had
borderline voltage for LVH, and 47 had LVH on the ECG. LV cineangiograms in
the right anterior oblique projection were analyzed for LV end-diastolic
volume, free wall thickness (h), semiminor radius (R), LV mass index
(LVMI), and the geometric relations described by h/R, mass/volume, and h .
R. Although mean LVMI was greater in patients whose ECG voltage was either
borderline or diagnostic of LVH, increased LVMI also occurred without LVH
on the ECG. None of the variables (h, R, h/R or mass/volume) reliably
indicated when LVH would be inscribed on the ECG. The product of h . R,
however, defined three electrocardiographic groups; all patients with LVH
on their ECG had h . R greater than 2.6 cm2. Wall thickening sufficient to
result in an increased LV mass did not result in LVH on the ECG unless
sufficient concurrent chamber dilatation was present. Thus, a critical
geometric relationship resulting from the interplay of wall thickness and
chamber dilatation is necessary for LVH to appear on the ECG. This finding
is consistent with the solid-angle theory of electrocardiography as it
relates to ventricular hypertrophy.
ARTICLES
Physiologic determinants of the electrocardiographic diagnosis of left ventricular hypertrophy