The Heart

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Chapter 11: THE RESTING ELECTROCARDIOGRAM LV HYPERTROPHY

As emphasized by Surawicz,111 since the advent of other noninvasive techniques, there has been a changing role for the ECG in the diagnosis of ventricular hypertrophy. Necropsy studies have exposed the superiority of echocardiography (see Chap. 13) with respect to electrocardiography to detect LV hypertrophy.111 Echocardiography is also a better method for the serial follow-up of changes during progression or regression of LV hypertrophy. Multiple criteria have been proposed to diagnose LV hypertrophy using necropsy or echocardiographic information49,112-115 (Tables 11-4 and 11-5). Of these, the Sokolow-Lyon criterion (SV1 + RV:- a >35 mm) is the most specific (>95 percent) but is not very sensitive («45 percent) (see Table 11-4). The Romhilt-Estes score has a specificity of 90 percent and a sensitivity of 60 percent in studies correlated with echocardiography. The following are some of the other criteria49: The Casale (modified Cornell) criterion (RaVL + SV3 >28 mm in men and >20 in women) is somewhat more sensitive but less specific than the Sokolow-Lyon criterion.116 The Talbot criterion117 (R >16 mm in ayjJ is very specific (>90 percent), even in the presence of MI and ventricular block, but not very sensitive. The Koito and Spodick criterion118 (RV6 > RV5) claims a specificity of 100 percent and a sensitivity of more than 50 percent. According to Hernandez Padial,119 a total 12-lead QRS voltage of greater than 120 mm is a good ECG criterion of LV hypertrophy in systemic hypertension and is better than those most frequently used. With echocardiography as the "gold standard," several authors postulated ECG criteria for diagnosis of LV hypertrophy in the presence of complete LBBB and LAFB120,121 (Tables 11-6 and 11-7). The high sensitivity and specificity reported by Gertsch et al.121 for diagnosis of LV hypertrophy with LAFB have not been corroborated in preliminary studies performed in our department (unpublished observations; nevertheless indicated in Table 11-7).

Table 11-4: Electrocardiographic Criteria for Left Ventricular Enlargement

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