Estimating Left Ventricular Mass from the Electrocardiogram across the Spectrum of LV Mass from Normal to Increased LV Mass in an Older Age Group.

OBJECTIVES: To examine the relationship of QRS voltages and left ventricular (LV) mass across the spectrum of individuals with different LV mass.

METHODS: Twenty QRS voltage measurements or combinations were determined in a consecutive series of 159 adults with an ECG and echocardiogram without previous myocardial infarction, left or right bundle branch block, pre-excitation, or electronic pacemaker.

RESULTS: The four strongest and significant correlations between QRS and LV mass were S in V4, deepest S wave in any precordial lead plus S in V4, S in V3, and S in V3 plus R in AVL times QRS duration. For men, the strength of the relationships were S in V3 ( F  = 33.8), deepest S wave in any precordial lead plus S V4 ( F  = 33.7), S in V3 plus R aVL ( F  = 29.9), S in V4 ( F  = 29.79), and deepest S in precordial leads ( F  = 17.9). The R wave in AVL alone did not correlate with LV mass. Criteria using the R wave in lateral precordial leads did not correlate as strongly with LV mass. For women, only S in V4 significantly correlated with LV mass. Overall, the R wave voltage in limb leads (AVL I or II) did not correlate with precordial S wave amplitudes. Univariate and multivariate analysis showed that some but not all QRS voltages correlated with each other. In multivariate analysis, using only single variables and not combination of QRS variables, the only significant relationship between QRS voltage and left ventricular mass was for men the S in V3 ( p = 0.04) and for women S in V4 ( p = 0.016) and R in V6 ( p = 0.04).

CONCLUSION: The S wave in V3 and V4 correlate most strongly with LV mass while the R wave in limb leads, including AVL, do not correlate.