International Journal of Cardiology, 34 (1992) 41-48 0 1992 Elsevier Science Publishers B.V. All rights reserved 0167-5273/92/$05.00 41 CARD10 01369 Limitations of the electrocardiographic diagnosis of left ventricular hypertrophy: the influence of left anterior hemiblock and right bundle branch block * Pietro Vincenzo Fragola, Camillo Autore, Giuseppina Magni, Matte0 Albertini, Luigi Pierangeli, Giancarlo Ruscitti and Dario Cannata Department of Internal Medicine, School of Cardiovascular Diseases, II Unitlersity of Rome, Italy (Received 21 March 1991; revision accepted 22 July 1991) Fragola PV, Autore C, Magni G, Aibertini M, Pierangeli L, Ruscitti G, Cannata D. Limitations of the electrocardiographic diagnosis of left ventricular hypertrophy: the influence of left anterior hemiblock and right bundle branch block. Int J Cardiol 1992;34:41-48. zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONML We analysed the performance of the electrocardiogram in diagnosing left ventricular hypertrophy in 70 patients with isolated left anterior hemihlock and in 75 patients with right bundle branch block, either isolated (44 cases) or associated (31 cases) with left anterior hemiblock. Left ventricular hypertrophy defined as an echocardiographically determined left ventricular mass > 261 g in men and 172 g in women or left ventricular mass index > 125 g/ rn’ in men and 112 g/m* in women was present in 48 subjects (57%) with isolated left anterior hemihlock and 33 subjects (44%) with right bundle branch block In patients with isolated left anterior hemiblock the best results were obtained using the SVl or SV2 + (RV6 + SV6) > 25 mm with 74% in sensitivity and 67% in specificity; the criterion SIR + (R + S) maximal in a precordial lead 2 30 mm showed a sensitivity of 74% but a specificity of 47%. In the whole group of patients with right bundle branch block none of the criteria nor combination of criteria achieved an acceptable performance (sensitivities ranged from 17% to 41% and specificities ranged from 54% to 85%). When these patients were divided according to the presence or absence of concomitant left anterior hemiblock the electrocardiographic indexes mostly showed, in comparison to whole group, higher values in sensitivity and lower values in specificity in right bundle branch block plus left anterior hemiblock and an opposite behaviour in isolated right bundle branch block. Thus, in investigating the usefulness of the electrocardiogram for left ventricular hypertrophy in the presence of right bundle branch block those patients with a coexistent left anterior hemiblock must be considered separately. However, from our data left ventricular hypertrophy was poorly defined by the electrocardio- gram in patients with left anterior hemiblock, right bundle branch block, or both. Key words: Electrocardiogram; Echocardiogram; Left ventricular hypertrophy; Left anterior hemiblock; Right bundle branch block Correspondence to: P.V. Fragola, MD, Dep. of Internal * Data from this article have been presented in part at Medicine, School of Cardiovascular Diseases, II University of the XVIIth International Congress on Electrocardiology, Flo- Rome, Via A. Torlonia 12, 00161 Rome, Italy. rence, Italy, September 26-29, 1990.