Left ventricular hypertrophy (LVH) with strain pattern

Left ventricular hypertrophy (LVH) with strain pattern

ECG showing gross LVH with strain in a case with severe aortic stenosis. The R waves in V5 and V6 are so tall that they are overlapping with the tracing in the channel above. ST segment depression and T wave inversion are seen in inferior and lateral leads. This is a pressure overload pattern which can be seen also in severe systemic hypertension and hypertrophic obstructive cardiomyopathy. In hypertrophic obstructive cardiomyopathy there may be associated prominent Q waves due to septal hypertrophy. In volume overload pattern the ST segment depression and T wave inversion are not usually seen while the R waves will be tall in lateral leads and the T waves upright and tall. A small narrow q wave is also seen in volume overload patterns due to aortic regurgitation or patent ductus arteriosus / ventricular septal defect with large left to right shunt. LVH with strain pattern can sometimes be seen in long standing severe aortic regurgitation, usually with associated left ventricular hypertrophy and systolic dysfunction.

The sensitivity of LVH strain pattern on ECG as a measure of LVH has ranged from 3.8% to 50% in various reports [1]. The same data quoted specificity ranging from 89.8% to 100%. They had extracted data from 61 published studies in this report.

Reference

1. Ogah OS, Oladapo OO, Adebiyi AA, Adebayo AK, Aje A, Ojji DB, Salako BL, Falase AO. Electrocardiographic left ventricular hypertrophy with strain pattern: prevalence, mechanisms and prognostic implications. Cardiovasc J Afr. 2008 Jan-Feb;19(1):39-45.