Simple Quantitative Vectorcardiographic Criteria for the Diagnosis of Right Ventricular Hypertrophy

Abstract

The vectorcardiogram is a useful supplement to the conventional electrocardiogram in the recognition of right ventricular hypertrophy. Many quantitative criteria have been proposed. However they are often too complicated for routine clinical application. Based on the distribution of the QRS loop area in the various quadrants in the vectorcardiogram in 198 normal subjects, three simple criteria for diagnosis of right ventricular hypertrophy are derived: 1) the anterior and rightward QRS loop area in the transverse plane is greater than 70% of the total; 2) the QRS loop area in the right posterior quadrant of the transverse plane is greater than 20% of the total; 3) the QRS loop area in the right inferior quadrant in the frontal plane is greater than 20% of the total. Vectorcardiogram recordings in 97 patients with atrial septal defect, mitral stenosis, and chronic obstructive lung disease with pulmonary hypertension met one or more of the criteria in 80 (83%). The conventional electrocardiogram of these patients was suggestive of right ventricular hypertrophy in 64 (66%). It is concluded that the proposed vectorcardiographic criteria provide a sensitive means for the diagnosis of right ventricular hypertrophy. Their specificity however was not tested.