Left Ventricular Hypertrophy
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Contents |
Introduction
- Electrocardiographic (ECG) criteria:
- tall left precordial R waves, deep right precordial S waves
- Sokolow-Lyon criteria
- S in V1 + R in V5 or V6 > 35 mm
- R in V5 or V6 > 26 mm
- Cornell criteria
- R in aVL + S in V3 > 20 mm (female)
- R in aVL + S in V3 > 28 mm (male)
- Casales criteria
- R in aVL + S in V3 > 35 mm (male) 25 mm (female)
- R in aVL + S on V3 > 22 mm (male) 12 mm (female) + T > 0 mm (< 40 years) > 2 mm (> 40 years)
- Romhilt-Estes scoring system
* :* R or S in any limb lead > 20 mm, or S in lead V1 or V2 > 30 mm, or R in lead V5 or V6 > 30 mm 3 pts :* left ventricular strain ST segment & T wave in opposite direction to QRS ::* no digitalis 3 pts ::* + digitalis 1 pt :* left atrial enlargement 3 pts :* left axis deviation (< -30 degrees) 2 pts :* QRS duration > 90 ms 1 pt :* intrinsicoid deflection in lead V5 or V6 > 50 ms 1 pt ------ * > 4 points = LVH total 13 pts
- Caution: LVH cannot be assessed in the presence of left bundle branch block (LBBB)
- Associated with 5-14% risk of LV systolic dysfunction [2]
Genetics
- polymorphism in ANF receptor type A gene associated with left ventricular hypertrophy & decreased serum atrial natriuretic factor [4]
More General Terms
References
- Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1240
- Journal Watch 24(16):127, 2004 a) Drazner MH, Rame JE, Marino EK, Gottdiener JS, Kitzman DW, Gardin JM, Manolio TA, Dries DL, Siscovick DS. Increased left ventricular mass is a risk factor for the development of a depressed left ventricular ejection fraction within five years: the Cardiovascular Health Study. J Am Coll Cardiol. 2004 Jun 16;43(12):2207-15. PMID: [1]
- Frohlich ED. Left ventricular hypertrophy: a 'factor of risk': mass is reversible, but is the risk? J Am Coll Cardiol. 2004 Jun 16;43(12):2216-8. No abstract available. PMID: [2] - Journal Watch 25(1):1, 2005 Okin PM, Devereux RB, Jern S, Kjeldsen SE, Julius S, Nieminen MS, Snapinn S, Harris KE, Aurup P, Edelman JM, Wedel H, Lindholm LH, Dahlof B; LIFE Study Investigators. Regression of electrocardiographic left ventricular hypertrophy during antihypertensive treatment and the prediction of major cardiovascular events. JAMA. 2004 Nov 17;292(19):2343-9. PMID: [3]
- Devereux RB, Wachtell K, Gerdts E, Boman K, Nieminen MS, Papademetriou V, Rokkedal J, Harris K, Aurup P, Dahlof B. Prognostic significance of left ventricular mass change during treatment of hypertension. JAMA. 2004 Nov 17;292(19):2350-6. PMID: [4] - Rabattu S et al, Association of atrial natriuretic peptide and type A natriuretic peptide receptor gene polymorphisms with left ventricular mass in human essential hypertension. J Am Coll Cardiol 2006, 48:499 PMID: [5]
- London B, Natriuretic peptides and cardiac hypertrophy J Am Coll Cardiol 2006, 48:506 PMID: [6]
