The diagnosis of left ventricular hypertrophy and left atrial hypertrophy are readily made from electrocardio¬graphic findings. Figure 1 shows a normal ECG Figs. 2 and 3 show features of left ventricular hypertrophy.
• The sum of the S wave in V1 (or V2 ) + the R wave in V5 ( or V6) is 40 mm (normal is less than 35 mm; in the normal tracing, Fig. 1, the sum is less than 30 mm).
• ST segment depression and T-wave inversion in leads V5 and V6 (left ventricular strain pattern).
• Left atrial hypertrophy.
The electrocardiogram, however, may not detect mild hypertrophy. Echocardiography is much more expensive but more specific and sensitive for ventricular hypertrophy than the electrocardiogram. An expensive MRI test is rarely required, but is extremely useful in differentiating
physiologic hypertrophy found in well-trained athletes as opposed to pathologic hypertrophy found in hypertrophic cardiomyopathy (see Figure 1 in the chapter Athletes and Sudden Cardiac Death).
A. Clinical study: Verdecchia et al.
Study question: A prospective observational multicenter investigation was done because only a few single-centered studies support the prognostic value of elevated left ventricular mass in uncomplicated hypertension. The prespecified aim was to explore the prognostic value of left ventricular mass in hypertension.

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