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. 1981 Apr;45(4):402–410. doi: 10.1136/hrt.45.4.402

Scoring technique for diagnosis of ventricular hypertrophy from three orthogonal lead electrocardiogram.

P W Macfarlane, C Y Chen, B Boyce, R S Fraser
PMCID: PMC482541  PMID: 6452889

Abstract

A prospective study for the development of scoring techniques for the diagnosis of ventricular hypertrophy from the three orthogonal lead electrocardiogram was undertaken. A total of 51 hearts was examined at necropsy in a training group on which the scoring techniques were developed and a test group of a further 82 hearts was studied to assess the sensitivity and specificity of the method. The hearts were classified as being normal or having left ventricular hypertrophy, right ventricular hypertrophy, biventricular hypertrophy, or were placed in a borderline category. These classifications were based on the measurement of the weight of the left ventricular free wall, the interventricular septum, and the right ventricular free wall. Classical electrocardiographic variables were selected and assigned a point score on the basis of their diagnostic value. The electrocardiographic diagnosis of left ventricular hypertrophy, right ventricular hypertrophy, and biventricular hypertrophy was then made when the relevant score exceeded four points. After excluding 25 cases which showed conduction defects or were regarded as borderline at necropsy, 57 cases remained in the test group for assessing the technique. The sensitivity and specificity for left ventricular hypertrophy were 65 per cent and 91 per cent, respectively. For right ventricular hypertrophy corresponding results were 53 and 90 per cent. For biventricular hypertrophy the sensitivity was lower at 42 per cent, with a corresponding specificity of 93 per cent. These results represent a considerable improvement over older techniques, with up to a tenfold increase in sensitivity being obtained. The technique can be applied with or without computer assistance.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ALLENSTEIN B. J., MORI H. Evaluation of electrocardiographic diagnosis of ventricular hypertrophy based on autopsy comparison. Circulation. 1960 Mar;21:401–412. doi: 10.1161/01.cir.21.3.401. [DOI] [PubMed] [Google Scholar]
  2. Bove K. E., Rowlands D. T., Scott R. C. Observations on the assessment of cardiac hypertrophy utilizing a chamber partition technique. Circulation. 1966 Apr;33(4):558–568. doi: 10.1161/01.cir.33.4.558. [DOI] [PubMed] [Google Scholar]
  3. Cokkinos D. V., Demopoulos J. N., Heimonas E. T., Mallios C., Papazoglou N., Vorides E. M. Electrocardiographic criteria of left ventricular hypertrophy in left bundle-branch block. Br Heart J. 1978 Mar;40(3):320–324. doi: 10.1136/hrt.40.3.320. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. FULTON R. M., HUTCHINSON E. C., JONES A. M. Ventricular weight in cardiac hypertrophy. Br Heart J. 1952 Jul;14(3):413–420. doi: 10.1136/hrt.14.3.413. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Gamboa R., Klingeman J. D., Pipberger H. V. Computer diagnosis of biventricular hypertrophy from the orthogonal electrocardiogram. Circulation. 1969 Jan;39(1):72–82. doi: 10.1161/01.cir.39.1.72. [DOI] [PubMed] [Google Scholar]
  6. Geva B., Elkayam U., Frishman W., Terdiman R., Laniado S. Determination of left ventricular wall thickening in patients with chronic systemic hypertension. Correlation of electrocardiography and echocardiography. Chest. 1979 Nov;76(5):557–561. doi: 10.1378/chest.76.5.557. [DOI] [PubMed] [Google Scholar]
  7. Hiroki T. Vectorcardiographic analysis of combined ventricular hypertrophy in adult patients. Adv Cardiol. 1976;16:370–375. doi: 10.1159/000398426. [DOI] [PubMed] [Google Scholar]
  8. Holt J. H., Jr, Barnard A. C., Kramer J. O., Jr Quantitative electrocardiography using a multiple dipole method. Adv Cardiol. 1976;16:117–120. doi: 10.1159/000398381. [DOI] [PubMed] [Google Scholar]
  9. LEVINE H. D., PHILLIPS E. An appraisal of the newer electrocardiography: correlations in one hundred and fifty consecutive autopsied cases. N Engl J Med. 1951 Nov 29;245(22):833–842. doi: 10.1056/NEJM195111292452201. [DOI] [PubMed] [Google Scholar]
  10. Liu C. K., DeCristofaro D. Sensitivity and specificity of electrocardiographic evaluation of LVH in 364 unselected autopsy cases. A criterion, Rv6 equal to or greater than 18 mm., is proposed. Am Heart J. 1968 Nov;76(5):596–604. doi: 10.1016/0002-8703(68)90159-2. [DOI] [PubMed] [Google Scholar]
  11. MAZZOLENI A., WOLFF R., WOLFF L., REINER L. CORRELATION BETWEEN COMPONENT CARDIAC WEIGHTS AND ELECTROCARDIOGRAPHIC PATTERNS IN 185 CASES. Circulation. 1964 Dec;30:808–829. doi: 10.1161/01.cir.30.6.808. [DOI] [PubMed] [Google Scholar]
  12. Macfarlane P. W. A modified axial lead system for orthogonal lead electrocardiography. Cardiovasc Res. 1969 Oct;3(4):510–515. doi: 10.1093/cvr/3.4.510. [DOI] [PubMed] [Google Scholar]
  13. Macfarlane P. W., Lorimer A. R., Lawrie T. D. Normal ranges of modified axial lead system electrocardiogram parameters. Br Heart J. 1971 Mar;33(2):258–265. doi: 10.1136/hrt.33.2.258. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. McCaughan D., Littmann D., Pipberger H. V. Computer analysis of the orthogonal electrocardiogram and vectorcardiogram in 939 cases with hypertensive cardiovascular disease. Am Heart J. 1973 Apr;85(4):467–482. doi: 10.1016/0002-8703(73)90491-2. [DOI] [PubMed] [Google Scholar]
  15. REINER L., MAZZOLENI A., RODRIGUEZ F. L., FREUDENTHAL R. R. The weight of the human heart. I. Normal cases. AMA Arch Pathol. 1959 Jul;68(1):58–73. [PubMed] [Google Scholar]
  16. Romhilt D. W., Bove K. E., Norris R. J., Conyers E., Conradi S., Rowlands D. T., Scott R. C. A critical appraisal of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy. Circulation. 1969 Aug;40(2):185–195. doi: 10.1161/01.cir.40.2.185. [DOI] [PubMed] [Google Scholar]
  17. Romhilt D. W., Estes E. H., Jr A point-score system for the ECG diagnosis of left ventricular hypertrophy. Am Heart J. 1968 Jun;75(6):752–758. doi: 10.1016/0002-8703(68)90035-5. [DOI] [PubMed] [Google Scholar]
  18. SCOTT R. C. The correlation between the electrocadiographic patterns of ventricular hypertrophy and the anatomic findings. Circulation. 1960 Feb;21:256–291. doi: 10.1161/01.cir.21.2.256. [DOI] [PubMed] [Google Scholar]

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