Echocardiographic parameters of left ventricular (LV) function were compared with the electrocardiographic findings in 40 patients with chronic severe aortic regurgitation. Total 12-lead QRS amplitude was linearly correlated with LV mass and its 'relative reduction' (less than 250 mm) indicated LV hypertrophy. Patients with an electrocardiographic 'strain' pattern had a marked increase LV stress (573 +/- 68 dyn). The association of high total 12-lead QRS amplitude and 'strain' indicate a moderately depressed ejection fraction (EF = 43 +/- 3). Finally, 'strain' and a 'relative reduction' of total 12-lead QRS amplitude were present in patients with a severe depression of EF and contractility. The predictive value of these electrocardiographic indices was confirmed during a mean follow-up of 49 months. In conclusion, the electrocardiogram remains an excellent, easy tool for anatomical and functional investigation of patients with aortic regurgitation.