Left ventricular hypertrophy

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Left ventricular hypertrophy is defined as left ventricular mass index > 118 g/m2 in men and > 104 g/m2 in women.[1]

Diagnosis

Electrocardiogram

Criteria

Various electrocardiographic criteria exist: Sokolow-Lyon index, Cornell voltage index, Cornell product, Gubner, and Romhilt-Estes score.[2] Sokolow-Lyon index

  • SV1+RV5>3.5 mV

or

  • V6>3.5 mV

Cornell voltage index

  • Males: RaVL+SV3>2.8 mV;
  • Females: RaVL+SV3>2.0 mV

Cornell product

  • Males: (SV3+RaVL)xQRS duration 2440 ms or more
  • Females: (SV3+(RaVL+8 mV))xQRS duration>2440 ms

Gubner criteria

  • RI+SII 25 mV or more

Romhilt-Estes score greater than 4 or 5 points:

  • Evidence of excessive voltage (any one of the following) - 3 points
    • largest R or S wave in limb leads 20 mV or more
    • S wave in V1
    • V2 30 mV or more
    • R wave in V5
    • V6 30 mV or more
  • Evidence of LV strain - 3 points (only 1 point if taking digitalis)
    • ST-T segment vector shifted opposite to QRS vector
  • Evidence of left atrial involvement - 3 points
    • terminal negativity of P wave in V1 1 mm or more with duration 0.04 s or more
  • Evidence of left axis deviation - 2 points
    • left axis –30° or less
  • Prolonged QRS duration - 1 point (0.09 s)
  • Intrinsicoid deflection - 1 point
    • intrinsicoid deflection (interval between start of QRS complex and peak of the R wave) in V5 or V6 0.05 s or more

Sensitivity and specificity

A systematic review found that the accuracy of the electrocardiographic indices and criteria for diagnosing left ventricular hypertrophy is:[2]

Treatment

Adrenergic beta-antagonists may be less effective according to meta-analyses[3][4] of randomized controlled trials such as LIFE[5] and others[6].

See also

References

  1. ↑ Molloy TJ, Okin PM, Devereux RB, Kligfield P (1992). "Electrocardiographic detection of left ventricular hypertrophy by the simple QRS voltage-duration product". J. Am. Coll. Cardiol. 20 (5): 1180–6. PMID 1401620. [e]
  2. ↑ 2.0 2.1 Pewsner D, Jüni P, Egger M, Battaglia M, Sundström J, Bachmann LM (2007). "Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review". BMJ 335 (7622): 711. DOI:10.1136/bmj.39276.636354.AE. PMID 17726091. Research Blogging.
  3. ↑ Fagard RH, Celis H, Thijs L, Wouters S (2009). "Regression of left ventricular mass by antihypertensive treatment: a meta-analysis of randomized comparative studies.". Hypertension 54 (5): 1084-91. DOI:10.1161/HYPERTENSIONAHA.109.136655. PMID 19770405. Research Blogging.
  4. ↑ Klingbeil AU, Schneider M, Martus P, Messerli FH, Schmieder RE (2003). "A meta-analysis of the effects of treatment on left ventricular mass in essential hypertension.". Am J Med 115 (1): 41-6. PMID 12867233. [e]
  5. ↑ Devereux RB, Dahlöf B, Kjeldsen SE, Julius S, Aurup P, Beevers G et al. (2003). "Effects of losartan or atenolol in hypertensive patients without clinically evident vascular disease: a substudy of the LIFE randomized trial.". Ann Intern Med 139 (3): 169-77. PMID 12899584. [e]
  6. ↑ Schulman SP, Weiss JL, Becker LC, Gottlieb SO, Woodruff KM, Weisfeldt ML et al. (1990). "The effects of antihypertensive therapy on left ventricular mass in elderly patients.". N Engl J Med 322 (19): 1350-6. DOI:10.1056/NEJM199005103221904. PMID 2139175. Research Blogging.
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