ISE/ISHNE expert consensus statement on the ECG diagnosis of left ventricular hypertrophy : The change of the paradigm
(2024) In Annals of Noninvasive Electrocardiology 29(1).- Abstract
The ECG diagnosis of LVH is predominantly based on the QRS voltage criteria. The classical paradigm postulates that the increased left ventricular mass generates a stronger electrical field, increasing the leftward and posterior QRS forces, reflected in the augmented QRS amplitude. However, the low sensitivity of voltage criteria has been repeatedly documented. We discuss possible reasons for this shortcoming and proposal of a new paradigm. The theoretical background for voltage measured at the body surface is defined by the solid angle theorem, which relates the measured voltage to spatial and non-spatial determinants. The spatial determinants are represented by the extent of the activation front and the distance of the recording... (More)
The ECG diagnosis of LVH is predominantly based on the QRS voltage criteria. The classical paradigm postulates that the increased left ventricular mass generates a stronger electrical field, increasing the leftward and posterior QRS forces, reflected in the augmented QRS amplitude. However, the low sensitivity of voltage criteria has been repeatedly documented. We discuss possible reasons for this shortcoming and proposal of a new paradigm. The theoretical background for voltage measured at the body surface is defined by the solid angle theorem, which relates the measured voltage to spatial and non-spatial determinants. The spatial determinants are represented by the extent of the activation front and the distance of the recording electrodes. The non-spatial determinants comprise electrical characteristics of the myocardium, which are comparatively neglected in the interpretation of the QRS patterns. Various clinical conditions are associated with LVH. These conditions produce considerable diversity of electrical properties alterations thereby modifying the resultant QRS patterns. The spectrum of QRS patterns observed in LVH patients is quite broad, including also left axis deviation, left anterior fascicular block, incomplete and complete left bundle branch blocks, Q waves, and fragmented QRS. Importantly, the QRS complex can be within normal limits. The new paradigm stresses the electrophysiological background in interpreting QRS changes, i.e., the effect of the non-spatial determinants. This postulates that the role of ECG is not to estimate LV size in LVH, but to understand and decode the underlying electrical processes, which are crucial in relation to cardiovascular risk assessment.
(Less)
- author
- organization
- publishing date
- 2024
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- ECG, left ventricular hypertrophy, new paradigm
- in
- Annals of Noninvasive Electrocardiology
- volume
- 29
- issue
- 1
- publisher
- Wiley-Blackwell
- external identifiers
-
- pmid:37997698
- scopus:85177592359
- ISSN
- 1082-720X
- DOI
- 10.1111/anec.13097
- language
- English
- LU publication?
- yes
- id
- 3f207123-9313-4dcb-b9bf-ae74dc6a0397
- date added to LUP
- 2024-01-09 15:04:40
- date last changed
- 2025-07-04 04:48:21
@article{3f207123-9313-4dcb-b9bf-ae74dc6a0397,
abstract = {{<p>The ECG diagnosis of LVH is predominantly based on the QRS voltage criteria. The classical paradigm postulates that the increased left ventricular mass generates a stronger electrical field, increasing the leftward and posterior QRS forces, reflected in the augmented QRS amplitude. However, the low sensitivity of voltage criteria has been repeatedly documented. We discuss possible reasons for this shortcoming and proposal of a new paradigm. The theoretical background for voltage measured at the body surface is defined by the solid angle theorem, which relates the measured voltage to spatial and non-spatial determinants. The spatial determinants are represented by the extent of the activation front and the distance of the recording electrodes. The non-spatial determinants comprise electrical characteristics of the myocardium, which are comparatively neglected in the interpretation of the QRS patterns. Various clinical conditions are associated with LVH. These conditions produce considerable diversity of electrical properties alterations thereby modifying the resultant QRS patterns. The spectrum of QRS patterns observed in LVH patients is quite broad, including also left axis deviation, left anterior fascicular block, incomplete and complete left bundle branch blocks, Q waves, and fragmented QRS. Importantly, the QRS complex can be within normal limits. The new paradigm stresses the electrophysiological background in interpreting QRS changes, i.e., the effect of the non-spatial determinants. This postulates that the role of ECG is not to estimate LV size in LVH, but to understand and decode the underlying electrical processes, which are crucial in relation to cardiovascular risk assessment.</p>}},
author = {{Bacharova, Ljuba and Chevalier, Philippe and Gorenek, Bulent and Jons, Christian and Li, Yi Gang and Locati, Emanuela T. and Maanja, Maren and Pérez-Riera, Andrés Ricardo and Platonov, Pyotr G. and Ribeiro, Antonio Luiz Pinho and Schocken, Douglas and Soliman, Elsayed Z. and Svehlikova, Jana and Tereshchenko, Larisa G. and Ugander, Martin and Varma, Niraj and Elena, Zaklyazminskaya and Ikeda, Takanori}},
issn = {{1082-720X}},
keywords = {{ECG; left ventricular hypertrophy; new paradigm}},
language = {{eng}},
number = {{1}},
publisher = {{Wiley-Blackwell}},
series = {{Annals of Noninvasive Electrocardiology}},
title = {{ISE/ISHNE expert consensus statement on the ECG diagnosis of left ventricular hypertrophy : The change of the paradigm}},
url = {{http://dx.doi.org/10.1111/anec.13097}},
doi = {{10.1111/anec.13097}},
volume = {{29}},
year = {{2024}},
}