The diagnostic value of electrocardiographic criteria for left ventricular hypertrophy in essential arterial hypertension alone and in combination with coronary heart disease

Objective: to evaluate the diagnostic significance of the electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) in 12 leads in patients with essential arterial hypertension (AH) and in AH in combination with ischemic heart disease (IHD) compared with echocardiography (EchoCG) data. Materials and methods: ECG and EchoCG were carried out in 165 patients with AH (n = 139) and AH with concommitant IHD (n=26). Results: EchoCG signs of LVH ("EchoCG +") were detected in 72 (51,7%) patients with AH and in 12 (46,1 %) patients in AH + IHD. In the EchoCG + group the electrocardiographic signs of LVH (Sokolov-Lyon index, Cornell product, Cornell index) were determined in 37 (30,5 %) hypertensive patients and in no case in the AH + IHD group. In the "EchoCG-" group, electrocardiographic signs of LVH were determined in 8 hypertensive patients and two in the AH + CHD group. The use of additional voltage criteria for LVH in the frontal plane leads (RI > 15 mm, R I + S III > 25 mm, R aVL > 12 mm) increased the detection of LVH from 30,5 % (n=22) to 51,3 % (n=37). The false negative ECG diagnosis of LVH was influenced by: positional features, interventricular conduction defect, metabolic disorders and high index body mass. Conclusion: The Sokolov-Lyon index, the Cornell index, the Cornell product have low sensitivity in the diagnosis of LVH (30,5 %). Adding the frontal plane leads voltage criteria for LVH may contribute to increase in electocardiographic LVH detection (51,3 %). The decrease in the sensitivity of the ECG criteria for LVH is mainly caused by the positional features of the heart, interventricular conduction defect, metabolic disorders and high index body mass.