The electrocardiographic findings in left ventricular hypertrophy and dilatation.

THE electrocardiographic patterns of subjects who had evidence at necropsy of left ventricular hypertrophy have been comprehensively reviewed by Seott.1 2 Although no close relationship can be demonstrated between any specific electrocardiographic abnormality and the heart weight, the left ventricular weight, the left ventricular wall thickness, or the ratio of left ventricular/ right ventricular wall thickness, a significant association is found between increasing heart weight and increasing electrocardiographic accuracy of diagnosis. According to Scott, the criteria of Sokolow,3 of Wilson,4 5 of Goldberger,6 and of Katz7 a-re, in this order, the most accurate in the diagnosis of left ventricular hypertrophy. Almost all such studies contain at least two implied assumptions. One is that heart weight and left ventricular weight can be substituted for thickness of the left ventricular wall. If depolarization spreads from endocardium to epicardium, weight alone cannot be used to correlate the electrocardiogram with left ventricular hypertrophy unless it is shown that weigh.t always varies directly with left ventricular wall thickness. Nor is it pernmissible to exclude hearts of normal weight if the left ventricular wall is hypertrophied. The second assumption that the thickness of the left ventricular wall at necropsy is identical with that during life is incorrect as even casual inspection of almost any angiocardiogram demonstrating left ventricular dis.ea.se will show. The left, ventricular cavity is almost always larger and the left ventricular wall thinner during life than at necropsy; at necropsy the heart is freed of the intraverLtricular pressure and of blood present during life. Further-