Electrocardiographic diagnosis of left ventricular hypertrophy
- Ary L Goldberger, MD
Ary L Goldberger, MD
- Section Editor — Electrocardiography
- Professor of Medicine
- Harvard Medical School
Left ventricular hypertrophy (LVH) refers to an increase in the size of myocardial fibers in the main cardiac pumping chamber. Such hypertrophy is usually the response to a chronic volume or pressure load.
●The two most important pressure overload states are systemic hypertension and aortic stenosis
●The major conditions associated with left ventricular volume overload are aortic or mitral valve regurgitation and dilated cardiomyopathy.
Ventricular septal defects cause both right and left ventricular volume overload, while hypertrophic cardiomyopathy is an example of an inherited condition in which LVH (usually with asymmetric septal hypertrophy) occurs in the absence of any apparent hemodynamic pressure or volume overload. A physiologic type of hypertrophy with increase in wall thickness and left ventricular end-diastolic volume may occur in trained athletes. The "athletic heart" is often associated with electrocardiogram (ECG) voltage criteria for LVH.
LVH is not an acute condition. It takes weeks and usually months to years to develop. Patients with LVH from any cause are at increased risk for major cardiovascular complications, including congestive heart failure and cardiac arrhythmias [1,2]. ECG markers of LVH also were associated with a significant increase in all-cause mortality in a large prospective study (ARIC) of the general, middle-aged population . These pathophysiologic outcomes may be fostered by the development of myocardial inflammation and fibrosis with LVH, as well as by the association of LVH due to systemic hypertension with renal and cerebrovascular disease. (See "Clinical implications and treatment of left ventricular hypertrophy in hypertension".)
- Kannel WB, Dannenberg AL, Levy D. Population implications of electrocardiographic left ventricular hypertrophy. Am J Cardiol 1987; 60:85I.
- Verdecchia P, Reboldi G, Di Pasquale G, et al. Prognostic usefulness of left ventricular hypertrophy by electrocardiography in patients with atrial fibrillation (from the Randomized Evaluation of Long-Term Anticoagulant Therapy Study). Am J Cardiol 2014; 113:669.
- Estes EH, Zhang ZM, Li Y, et al. The Romhilt-Estes left ventricular hypertrophy score and its components predict all-cause mortality in the general population. Am Heart J 2015; 170:104.
- Goldberger AL, Goldberger ZD, Shvilkin A. Goldberger's Clinical Electrocardiography: A Simplified Approach, 8th ed, Elsevier/Saunders, Philadelphia 2012.
- Devereux RB. Is the electrocardiogram still useful for detection of left ventricular hypertrophy? Circulation 1990; 81:1144.
- de Vries SO, Heesen WF, Beltman FW, et al. Prediction of the left ventricular mass from the electrocardiogram in systemic hypertension. Am J Cardiol 1996; 77:974.
- Mirvis D, Goldberger AL. Electrocardiography. In: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 10th ed, Mann DL. (Ed), Elsevier/Saunders, Philadelphia 2014.
- Mirvis, DM, Goldberger, AL. Electrocardiography. In: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed, Bonow, RO, Mann, DL, Zipes, DP, Libby, P (Eds), W.B. Saunders, Philadelphia 2011.
- Okin PM, Devereux RB, Nieminen MS, et al. Relationship of the electrocardiographic strain pattern to left ventricular structure and function in hypertensive patients: the LIFE study. Losartan Intervention For End point. J Am Coll Cardiol 2001; 38:514.
- Okin PM, Devereux RB, Fabsitz RR, et al. Quantitative assessment of electrocardiographic strain predicts increased left ventricular mass: the Strong Heart Study. J Am Coll Cardiol 2002; 40:1395.
- Bang CN, Devereux RB, Okin PM. Regression of electrocardiographic left ventricular hypertrophy or strain is associated with lower incidence of cardiovascular morbidity and mortality in hypertensive patients independent of blood pressure reduction - A LIFE review. J Electrocardiol 2014; 47:630.
- Shipsey SJ, Bryant SM, Hart G. Effects of hypertrophy on regional action potential characteristics in the rat left ventricle: a cellular basis for T-wave inversion? Circulation 1997; 96:2061.
- Mehta A, Jain AC, Mehta MC, Billie M. Usefulness of left atrial abnormality for predicting left ventricular hypertrophy in the presence of left bundle branch block. Am J Cardiol 2000; 85:354.
- Levy D, Labib SB, Anderson KM, et al. Determinants of sensitivity and specificity of electrocardiographic criteria for left ventricular hypertrophy. Circulation 1990; 81:815.
- Elizari MV, Acunzo RS, Ferreiro M. Hemiblocks revisited. Circulation 2007; 115:1154.
- Rautaharju PM, Manolio TA, Siscovick D, et al. Utility of new electrocardiographic models for left ventricular mass in older adults. The Cardiovascular Health Study Collaborative Research Group. Hypertension 1996; 28:8.
- Casale PN, Devereux RB, Alonso DR, et al. Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings. Circulation 1987; 75:565.
- Murphy ML, Thenabadu PN, de Soyza N, et al. Sensitivity of electrocardiographic criteria for left ventricular hypertrophy according to type of cardiac disease. Am J Cardiol 1985; 55:545.
- Fragola PV, Colivicchi F, Fabrizi E, et al. Assessment of left ventricular hypertrophy in patients with essential hypertension. A rational basis for the electrocardiogram. Am J Hypertens 1993; 6:164.