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Variable patterns of ST-T abnormalities in patients with left ventricular hypertrophy and normal coronary arteries
F U Huwez1, S D Pringle, P W Macfarlane
1University Department of Medical Cardiology, Royal Infirmary, Glasgow.
Insights
Electrocardiogram abnormalities in left ventricular hypertrophy (LVH) without coronary artery disease can vary. The typical left ventricular strain pattern is not always present, potentially impacting LVH diagnosis accuracy.
Area of Science:
- Cardiology
- Clinical Electrocardiography
Background:
- The classic electrocardiogram (ECG) pattern for left ventricular hypertrophy (LVH) involves ST depression and asymmetrical T wave inversion (left ventricular strain).
- Patients with LVH may also have coexisting ischemic heart disease, complicating ECG interpretation.
- This study revises ECG criteria for LVH by examining ST-T wave configurations in patients with confirmed LVH and normal coronary arteries.
Purpose of the Study:
- To assess the ST-T wave configuration in patients with echocardiographically confirmed left ventricular hypertrophy (LVH) and normal coronary arteries.
- To determine the prevalence of the typical left ventricular strain pattern in this specific patient group.
- To evaluate how variable ST-T abnormalities in LVH without coronary artery disease affect diagnostic accuracy.
Main Methods:
- Echocardiography was used to confirm left ventricular hypertrophy (LVH) in 24 patients.
- Cardiac catheterization confirmed normal coronary arteries in all participants.
- Patients with LVH and ST-T abnormalities in lateral ECG leads were selected, excluding those with digitalis use, electrolyte disturbances, prior myocardial infarction, or conduction defects.
Main Results:
- The typical left ventricular strain pattern, characterized by asymmetrical T wave inversion, was observed in approximately two-thirds (63%) of patients.
- The remaining 37% of patients exhibited variable ST-T abnormalities, including flat ST depression and isolated T wave inversions (symmetrical or asymmetrical).
- These non-specific ST-T changes were observed in the anterolateral leads of the electrocardiogram.
Conclusions:
- Left ventricular hypertrophy (LVH) without coronary artery disease can manifest with diverse ST-T abnormalities in the anterolateral leads.
- These variable changes include the classic left ventricular strain pattern and non-specific ST-T alterations.
- Non-specific ST-T abnormalities may reduce the accuracy of ECG criteria for diagnosing LVH, as they can be mistaken for signs of coronary artery disease.
Background:
Classically, the ST-T configuration in the electrocardiogram of patients with left ventricular hypertrophy is said to have a typical pattern of ST depression together with asymmetrical T wave inversion (the so-called left ventricular strain pattern). However, many patients with left ventricular hypertrophy may also have ischaemic heart disease. To revise the electrocardiographic criteria for left ventricular hypertrophy the ST-T configuration in patients with left ventricular hypertrophy documented by echocardiography and with normal coronary arteries was assessed.
Methods:
24 patients were selected for this study. All had left ventricular hypertrophy documented by echocardiography, normal coronary arteries by cardiac catheterisation, and ST and/or T wave abnormalities in the lateral leads of their electrocardiogram. There were eight patients with aortic valve disease and 16 with hypertension who had coronary angiography as part of an investigation into the risk factors of sudden cardiac death caused by hypertensive left ventricular hypertrophy. No patient was receiving digitalis preparations or had electrolyte disturbances, and none had a previous myocardial infarction or ventricular conduction defect.
Results:
Typical electrocardiographic evidence of left ventricular strain was found in approximately two thirds (63%) of patients and 95% of this subgroup had asymmetrical T wave inversion. Flat ST segment depression, with or without T wave inversion or isolated T wave inversion (symmetrical or asymmetrical) in the anterolateral leads, was seen in the remaining 37% of patients.
Conclusions:
These findings indicate that left ventricular hypertrophy without coronary artery disease can cause variable types of ST-T abnormalities in the anterolateral leads including the typical left ventricular strain pattern and non-specific ST-T changes. Non-specific abnormalities could not be distinguished from those of coronary artery disease and may adversely affect the accuracy of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy because they do not accord with the criteria for left ventricular strain.