Left ventricular hypertrophy: An electrocardiographic and angiocardiographic study in children with systolic overload of the left ventricle

The left ventricular wall thickness was measured on angiocardiograms in 83 children and infants with coarctation of the aorta or aortic valvular stenosis. The measurements were not corrected for image distortion from the nonparallel roentgen rays. The degree of hypertrophy was assessed by comparison with “normal” subjects in the same weight group. Twenty-five of the patients were found to have a left ventricular wall thickness within normal limits; 44 cases had a left ventricular wall not more than 50 per cent thicker than normal; in the remaining 14 cases it was more than 50 per cent greater than normal. The most advanced hypertrophy recorded was slightly more than twice the upper normal limit for corresponding weight. A comparison was made between the degree of hypertrophy as assessed by angiocardiography and the electrocardiographic criteria of hypertrophy. Although there seemed to be a general agreement between the degree of anatomic hypertrophy and the R amplitude in left precordial leads, the sum of (RV 5 6 + SV 1) and the recorded S-T changes, there was no statistically significant correlation between any one of these electrocardiographic criteria and the presence or absence of hypertrophy of the left ventricle. It is concluded that the electrocardiographic changes in patients with increased systolic overload of the left ventricle are probably related to myocardial factors other than the anatomic dimensions of the left ventricular wall. In our present state of development, the interpretation of the electrocardiogram with respect to moderate left ventricular hypertrophy is unsatisfactory and may be erroneous.