Right Velntricular Hypertrophy

Right Velntricular Hypertrophy II. Correlation of Electrocardiographic Right Ventricular Hypertrophy with the Anatomic Findings By ISOM C. WALKER, JR., M.D., RALPH C. SCOTT, M.D., AND ROBERT A. HELM, M.D. Twelve cases whose electrocardiograms fulfilled at least one criterion of Sokolow and Lyon for right ventricular hypertrophy were examined at autopsy. Eight of the 12 demonstrated right ventricular hypertrophy anatomically. Eleven of the 12 cases had diseases usually associated with increased pressure in the right ventricle and pulmonary artery and with increased total pulmonary resistance. It is likely that factors other than muscle mass contribute significantly to the electrocardiographic pattern of right ventricular hypertrophy. IN a previous study from this laboratory, cases showing isolated right ventricular hypertrophy at autopsy were studied to determine the frequency of concomitant electrocardiographic evidence of right ventricular hypertrophy.' The correlation was surprisingly poor. Using the criteria of Sokolow and Lyon,2 only 5 of 22 cases, with isolated right ventricular enlargement at autopsy, could have been diagnosed from the electrocardiogram. Only 3 of the 22 cases fulfilled the criteria of Myers and co-workers.3 The present study was under- taken to determine the reliability of electrocardiograms demonstrating the pattern of right ventricular hypertrophy. Other authors have stated that if the electrocardiogram shows the pattern of right ventricular hypertrophy, this diagnosis will be substantiated at autopsy. Sokolow and Lyon2 found anatomic confirma- tion in 17 of 18 instances when their criteria for right ventricular hypertrophy were used. Levine and Phillips4 reported correlation in eight of eight cases of right ventricular hypertrophy. Katz and his colleagues5 reported correlation in seven of eight cases. METHOD Electrocardiographic records fulfilling at least one criterion suggested by Sokolow and Lyon2 were From the Cardiac Laboratory, Cincinnati General Hospital, and the Department of Internal Medicine, College of Medicine, University of Cincinnati, Cin- cinnati, Ohio. Dr. Helm is a Public Health Service Research Fel- low of the National Heart Institute. 223 studied. Those showing an R' in V, or a delay in the onset of the intrinsicoid deflection in V1 of greater than 0.05 second or other criteria of in- complete right bundle-branch block, or complete right bundle-branch block were excluded from the study, although, as demonstrated by Myers and his associates,3 these findings often connote anatomic right ventricular hypertrophy. Twelve adult cases who fulfilled the above criteria and who had had an autopsy, including a determination of heart weight and ventricular wall thicknesses were in- cluded in this study. This survey covered a period of five years. The criteria for anatomic right ventricular hypertrophy were heart weight exceeding the mean standard deviation from normal for body weight' and a right ventricular thickness of 5 mm. or more7-10 or of 4 mm. in the presence of dilatation.' RESULTS Table 1 shows the analysis of the electrocardiograms of the 12 cases studied. Five of the 12 had a Q wave in Vi. Table 2 demon- strates the comparison of these findings with criteria of Sokolow and Lyon,2 of Myers and colleagues'* abnormal "P" waves" and stand- * Myers, Klein and Stofer's criteria for right ventricular hypertrophy: A. Pattern of right ventricular hypertrophy in leads V, to V6. (1) Reversal in ratio of the amplitudes of the R and S waves in V, and V6 characterized by an abnormally large R in proportion to S in V,, a diminu- tion in ratio in leads further to the left and a prom- inent S in V6. (2) Time interval from beginning of QRS to onset of intrinsicoid deflection that was abnormally long in V, and greater than in V5 or V6. (3) Tendency to a small Q wave in V,. (4) Tendency to inversion of the T wave in V,, and to upright T wave in V6. (5) Total duration of QRS less than 0.12 second and generally within the normal range. (6) Circulation, Volume XI, February, 1955 Downloaded from http://ahajournals.org by on June 20, 2023

Right Velntricular Hypertrophy

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