Prevalence and prognosis of electrocardiographic left ventricular hypertrophy, ST segment depression and negative T-wave. The Copenhagen City Heart Study

Larsen, Casper

doi:10.1053/euhj.2001.2774

Cited by 124 publications

(93 citation statements)

References 30 publications

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“…It may also reflect differences in MI endpoint definition applied in the [14]. However, this is a relatively low-prevalence condition (5-10%) [41], and not having these data available would lead to our estimates being slight underestimates. Studies indicate that use of lipid-lowering agents in HIVinfected patients is associated with moderate effects on lipid levels [42,43].…”

Section: Discussionmentioning

confidence: 70%

The use of the Framingham equation to predict myocardial infarctions in HIV‐infected patients: comparison with observed events in the D:A:D Study

et al. 2006

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The D:A:D (Data Collection on Adverse Events of Anti-HIV Drugs) Study, a prospective observational study on a cohort of 23 468 patients with HIV infection, indicated that the incidence of myocardial infarction (MI) increased by 26% per year of exposure to combination antiretroviral treatment (CART). However, it remains unclear whether the observed increase in the rate of MI in this population can be attributed to changes in conventional cardiovascular risk factors. ObjectiveTo compare the number of MIs observed among participants in the D:A:D Study with the number predicted by assuming that conventional cardiovascular risk equations apply to patients with HIV infection. MethodsThe Framingham equation, a conventional cardiovascular risk algorithm, was applied to individual patient data in the D:A:D Study to predict rates of MI by duration of CART. A series of sensitivity analyses were performed to assess the effect of model and data assumptions. Predictions were extrapolated to provide 10-year risk estimates, and various scenarios were modelled to assess the expected effect of different interventions. ResultsIn patients receiving CART, the observed numbers of MIs during D:A:D follow up were similar to or somewhat higher than predicted numbers: 9 observed vs 5.5 events predicted, 14 vs 9.8, 22 vs 14.9, 31 vs 23.2 and 47 vs 37.0 foro1 year, 1-2 years, 2-3 years, 3-4 years and 44 years CART exposure, respectively. In patients who had not received CART, the observed number of MIs was fewer than predicted (3 observed vs 7.6 predicted). Nine per cent of the study population have a predicted 10-year risk of MI above 10%, a level usually associated with initiation of intervention on risk factors. ConclusionsA consistent feature of all analyses was that observed and predicted rates of MI increased in a parallel fashion with increased CART duration, suggesting that the observed increase in risk of MI may at least in part be explained by CART-induced changes in conventional risk factors. These , to predict the rate of MI that would have been expected during the D:A:D Study follow up based on patients' risk factors for CVD and to compare this with the observed rate. This would allow an assessment of whether the overall cardiovascular risk in HIV-infected individuals in the D:A:D Study is similar to that among uninfected patients with similar risk profiles. In addition, this analysis would also help to determine whether the observed increased risk of MI with duration of CART can be explained by changes in conventional cardiovascular risk factors that occur over time. We hypothesized that, if the increased risk was mediated through such risk factors, then it would be expected that the predicted rates of MI would parallel the increased rates observed with increasing duration of CART during follow up, both overall and according to age and gender [15][16][17].A basic principle of prevention is that the intensity of risk-reduction measures should be adjusted to a person's absolute risk. Various preventive guidelines have been de...

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Section: Discussionmentioning

confidence: 70%

The use of the Framingham equation to predict myocardial infarctions in HIV‐infected patients: comparison with observed events in the D:A:D Study

et al. 2006

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“…In the Copenhagen City Heart Study (a population-based study), men younger than 55 years of age with voltage-only LVH (employing the Minnesota code) had the same risk of developing future coronary artery disease and myocardial infarction as those with a normal ECG. 13 This 20 In addition, the Framingham investigators found that the excess CV risk associated with voltage-only LVH was eliminated when adjusted for hypertension. 21 They postulated that the voltageonly LVH in hypertensive individuals reflects chiefly the severity and duration of the associated hypertension and therefore signifies ventricular muscle hypertrophy without myocardial damage.…”

Section: Voltage Ecg Lvh Criteria As a Prognostic Indicatormentioning

confidence: 99%

The prognostic value of the ECG in hypertension: where are we now?

Ang

Lang

2008

J Hum Hypertens

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In hypertension, the presence of left ventricular hypertrophy (LVH) is associated with increased risk of both cardiovascular morbidity and mortality. To date, the electrocardiogram (ECG) remains the cornerstone of LVH diagnosis in clinical practice because it is universally available, technically easy to perform and highly specific. In the most recent European Society of Hypertension/European Society of Cardiology guidelines for the treatment of arterial hypertension, the Sokolow-Lyon voltage criterion was recommended as part of all routine assessment of subjects with hypertension. However, the use of the ECG in the diagnosis of LVH is somewhat limited by its poor sensitivity. In this review article, we discuss the individual strength and weaknesses of the commonly used ECG criteria in diagnosing LVH. In addition, we present the latest data on the prognostic significance of ECG LVH and the survival differences conferred in different genders. In view of the recent Losartan Intervention for Endpoint Reduction in Hypertension trial, the prognostic benefit of LVH regression will also be addressed. Finally, with the wider availability of echocardiography, the role of combining both modalities to improve risk stratification in hypertension is reviewed.

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“…Although a number of previous studies have demonstrated the predictive value of ECG LV hypertrophy criteria which include some measure of the qualitative ECG strain pattern in their determination for the development of heart failure (8-12), these studies did not examine the predictive value of strain alone. In addition, among studies that examined ECG strain alone for Cardiovascular outcomes (7,(13)(14)(15)(16)(17)(18), the relationship of ECG strain to developing heart failure was evaluated in only one (7). In a previous report on hypertensive patients with ECG LV hypertrophy in the LIFE study (7), typical strain on the baseline ECG was a significant predictor of new-onset heart failure and heart failure mortality.…”

mentioning

confidence: 99%

“…First, it is unclear to what degree these findings in American Indians can be extrapolated to other ethnic populations. However, the demonstrated predictive value of ECG strain and minor degrees of STD for Cardiovascular morbidity and mortality in other populations (7,8,(14)(15)(16)(17)(18)(19) quantitative analysis of lateral STD will stratify the risk of developing heart failure in other populations as well. Second, the absence of information from serial ECGs precludes analysis of the impact of changes in STD on risk.…”

mentioning

confidence: 99%

Usefulness of Quantitative Assessment of Electrocardiographic ST Depression for Predicting New-Onset Heart Failure in American Indians (from the Strong Heart Study)

Okin

Roman

Lee

et al. 2007

The American Journal of Cardiology

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The qualitative ECG strain pattern of ST depression (STD) and T-wave inversion is strongly associated with coronary heart disease and left ventricular (LV) hypertrophy and is an independent predictor of new-onset heart failure in hypertensive patients. However, whether quantitative measures of STD in the lateral precordial predict new heart failure is unclear. Digital ECGs were examined in 2,059 American Indian participants in the second Strong Heart Study examination with no history of heart failure. The absolute magnitude of ST segment deviation was measured by computer to the nearest 5 μV in leads V 5 and V 6 . During 5.7±1.4 years follow-up, heart failure developed in 77 participants (3.7%). Participants who developed heart failure had greater STD in leads V 5 or V 6 (−11±35 vs 12±27 μV, p<0.001) than those who did not. In univariate Cox analyses, Address Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. STD was a significant predictor of new heart failure, with each 10 μV greater STD associated with a 31% greater risk of heart failure (hazard ratio [HR] 1.31, 95% CI 1.24-1.39). Increasing STD grouped according to quartiles was strongly associated with the development of heart failure, with step-wise increasing risk of heart failure compared with the lowest quartile of STD for the second (HR 2.39, 95% CI 0.77-7.40), third (HR 3.01, 95% CI 1.00-9.08) and fourth quartile of STD (HR 9.06,). In Cox multivariate analyses controlling for age, gender, diabetes, coronary heart disease, albuminuria and for other baseline risk factors, STD remained a significant predictor of incident heart failure (HR 1.22, 95% CI 1.13-1.32, per 10 μV increment in STD, p<0.001). In conclusion, increasing STD in the lateral precordial leads is strongly associated with an increased risk of developing heart failure, independent of other risk factors for new heart failure. NIH Public Access Keywordselectrocardiogram; heart failure; hypertrophy Computerized measurement of the degree of ECG ST depression (STD) in the lateral precordial leads has demonstrated that increasing magnitude of STD in leads V 5 and/or V 6 is associated with higher left ventricular (LV) mass and greater prevalence of anatomic LV hypertrophy (1). Although the magnitude of STD has been demonstrated to predict all-cause and cardiovascular mortality independent of the predictive value of ECG and echocardiographic LV hypertrophy (2), whether greater STD in the lateral precordial leads on the standard rest ECG is associated with increased risk of new-onset heart failure has not been examined. Therefore, the present study e...

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Prevalence and prognosis of electrocardiographic left ventricular hypertrophy, ST segment depression and negative T-wave. The Copenhagen City Heart Study

Cited by 124 publications

References 30 publications

The use of the Framingham equation to predict myocardial infarctions in HIV‐infected patients: comparison with observed events in the D:A:D Study

The use of the Framingham equation to predict myocardial infarctions in HIV‐infected patients: comparison with observed events in the D:A:D Study

The prognostic value of the ECG in hypertension: where are we now?

Usefulness of Quantitative Assessment of Electrocardiographic ST Depression for Predicting New-Onset Heart Failure in American Indians (from the Strong Heart Study)

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