Detection of Left Ventricular Hypertrophy?

E lectrocardiographic (ECG) methods of detecting left ventricular hypertrophy (LVH) have played an important role in the understanding of clinical heart disease. It has long been recognized that the risk of developing coronary heart disease or complications of hypertension is higher in individuals with LVH detected by ECG than in otherwise comparable subjects with normal ECGs.1,2 Early trials of antihypertensive therapy revealed that the benefit of treatment was also greatest in patients identified as being at high risk for developing coronary heart disease because ofLVH detected by ECG or other evidence of preexisting heart disease.3 Based on these results, LVH detected by ECG has been accepted as a major risk factor for subsequent cardiac events. However, the practical usefulness of ECGdetermined LVH for identifying high-risk patients has recently been questioned. The principal reason for this is that ECG-detected LVH occurs in only a small proportion of patients (e.g., 5% or fewer of those with hypertension of average severity4). As a result, most patients who will suffer cardiac morbidity remain undetected by ECG.