Electrocardiography-left ventricular mass discrepancies in left ventricular hypertrophy: electrocardiography imperfection or beyond perfection?

The problem of discrepancies between left ventricular mass (LVM) and electrocardiography (ECG) findings in diagnosis of left ventricular hypertrophy (LVH) is approached from the perspective of the diagnostic ability of ECG. Contrary to current clinical understanding of LVH as an increase in LVM, the LVH is defined as the organ manifestation of the hypertrophic growth of cardiomyocytes accompanied by changes in interstitium. This complex understanding of the hypertrophic rebuilding of LV myocardium in LVH is the crucial requirement to understand the role of ECG in LVH diagnosis. The basic statements of the article are based on the fact that ECG provides information on the electrical field generated by the heart; therefore, (1) ECG cannot be a surrogate method for the LVM estimation by its nature. The hypothesis that the ECG estimates LVM requires modification for the additional effects of myocardial tissue changes and conduction on the ECG. (2) The added value of ECG in LVH diagnosis is given by its ability to register the electrical field of the heart and thus to estimate the electrical status of the myocardium.