Relationship of electrocardiographic left ventricular hypertrophy to mortality and cardiovascular morbidity in high-risk patients

Lonn, Eva; Mathew, James; Pogue, Janice; Johnstone, David E.; Danisa, Kola; Bosch, Jackie; Baird, Michael G.; Sleight, Peter; Yusuf, Salim

doi:10.1097/01.hjr.0000106836.977722.cf

Cited by 32 publications

(18 citation statements)

References 32 publications

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“…16,17 In this longitudinal population-based study, the risk of fatal and nonfatal CV morbid events increased from threefold to eightfold higher in middle-aged persons with ECG-LVH compared to normal adults of similar age, and this finding remained significant after adjustment for coexistent risk factors. It should be noted that these findings relate to ST-T abnormalities (LV strain defined as ST-J point depressionX0.1 mV þ inverted 12 In this landmark trial, LVH defined solely by the Sokolow-Lyon voltage criterion was found to be an independent predictor of all cause deaths, CV death and heart failure. 12 The association with risk of heart failure was particularly pronounced (a twofold increase), considering the fact that all patients had normal LV ejection fraction at study entry.…”

Section: Voltage Ecg Lvh Criteria As a Prognostic Indicatormentioning

confidence: 70%

“…It should be noted that these findings relate to ST-T abnormalities (LV strain defined as ST-J point depressionX0.1 mV þ inverted 12 In this landmark trial, LVH defined solely by the Sokolow-Lyon voltage criterion was found to be an independent predictor of all cause deaths, CV death and heart failure. 12 The association with risk of heart failure was particularly pronounced (a twofold increase), considering the fact that all patients had normal LV ejection fraction at study entry. A link between diastolic dysfunction and ECG LVH was postulated.…”

Section: Voltage Ecg Lvh Criteria As a Prognostic Indicatormentioning

confidence: 70%

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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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Section: Voltage Ecg Lvh Criteria As a Prognostic Indicatormentioning

confidence: 70%

Section: Voltage Ecg Lvh Criteria As a Prognostic Indicatormentioning

confidence: 70%

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

Ang

Lang

2008

J Hum Hypertens

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“…In contrast, Lonn et al 32 found no difference in the baseline prevalence of diabetes among high-risk patients with and without ECG LVH by Sokolow-Lyon voltage criteria enrolled in the Heart Outcomes Prevention Evaluation (HOPE) trial (39.1% versus 38.1%). The present study demonstrates that diabetes is associated with an increased prevalence and severity of ECG LVH by Cornell product criteria and that this association is independent of clinical , and all-cause mortality (E) by time-varying presence or absence of LVH by Cornell voltage-duration product criteria using a threshold value of 2440 mm · ms. DM indicates patients with diabetes; non-DM, patients without diabetes; and n, number of patients in each group at baseline and at 2 and 4 years of study.…”

Section: Diabetes and Lvhmentioning

confidence: 93%

Impact of Diabetes Mellitus on Regression of Electrocardiographic Left Ventricular Hypertrophy and the Prediction of Outcome During Antihypertensive Therapy

et al. 2006

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Background-Diabetes mellitus is associated with increased cardiovascular (CV) morbidity and mortality and with greater ECG left ventricular hypertrophy (LVH); however, it is unclear whether diabetes attenuates regression of hypertensive LVH and whether regression of ECG LVH has similar prognostic value in diabetic and nondiabetic hypertensive individuals. Methods and Results-A total of 9193 hypertensive patients (1195 with diabetes) in the Losartan Intervention For Endpoint (LIFE) Reduction in Hypertension Study were treated with losartan-or atenolol-based regimens and followed up with serial ECG and blood pressure determinations at baseline and 6 months and then yearly until death or study end. ECG LVH was defined with gender-adjusted Cornell voltage-duration product (CP) criteria Ͼ2440 mm · ms. After a mean follow-up of 4.8Ϯ0.9 years, patients with diabetes had less regression of CP LVH (Ϫ138Ϯ866 versus Ϫ204Ϯ854 mm · ms, PϽ0.001), remained more likely to have LVH by CP (56.0% versus 48.1%, PϽ0.001), and had higher rates of CV death, myocardial infarction, stroke, and all-cause mortality and of the LIFE composite end point of CV death, myocardial infarction, or stroke. In multivariable Cox proportional hazards models, in-treatment regression or absence of ECG LVH by CP was associated with between 17% and 35% reductions in event rates in patients without diabetes but did not significantly predict outcome in patients with diabetes. Conclusions-Hypertensive patients with diabetes have less regression of CP LVH in response to antihypertensive therapy than patients without diabetes, and regression of ECG LVH is less useful as a surrogate marker of outcomes in hypertensive patients with diabetes. These findings may in part explain the higher CV morbidity and mortality in hypertensive patients with diabetes, and the absence of a demonstrable improvement in prognosis in diabetic patients in response to regression of ECG LVH suggests a more complex interrelation between underlying LV structural and functional abnormalities and outcome in these patients. (Circulation. 2006;113:1588-1596.)

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“…1 Electrocardiography (ECG) has the advantages of low costs, simplicity and almost ubiquitous diffusion; LVH detected by the Sokolow-Lyon index (SV 1 þ RV 5-6 >38 mm) or by the Cornell voltage QRS duration product (>2440 mm*ms) is an independent predictor of CV events, 2,3 and ECG can also be used to detect patterns of ventricular overload or 'strain' (known to indicate more severe risk), 2 ischaemia, conduction defects and arrhythmias. However, it is well known that the sensitivity of ECG to detect LVH is low, independently of the definition of LVH.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and predictors of left ventricular hypertrophy in patients with hypertension and normal electrocardiogram

Nardi

Palermo

Mulè

et al. 2012

Eur J Prev Cardiolog

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Background: Electrocardiography (ECG) has low sensitivity for detecting left ventricular hypertrophy (LVH), while echocardiography cannot be routinely performed. Design/methods: In this study we evaluate the prevalence of LVH and diastolic dysfunction in hypertensive patients with normal ECG. We excluded patients with cardiovascular (CV) diseases, diabetes, chronic kidney disease, or presenting ECG-LVH or other ECG anomalies. The enrolled 440 hypertensive patients underwent echocardiographic examination (Acuson Sequoia 512); LV mass was indexed by body surface area (LVMI) and LVH was defined as LVMI >125 g/m 2 in men and >110 g/m 2 in women. Diastolic function was evaluated by mitral inflow and tissue Doppler imaging (TDI). Results: The prevalence of LVH was 8.18% (95% confidence interval [CI] 5.97-11.1%). Multiple regression analysis showed that the only variable independently associated with LVH was duration of hypertension (p < 0.001). The receiver operating characteristic (ROC) curve showed that duration of hypertension was a powerful predictor of LVH, with an area under the curve (AUC) of 0.878 and p < 0.0001. Further, in patients with LVH the mean difference of LVMI from the cut-off value for LVH was 12.3 AE 9.19 g/m 2 . Diastolic dysfunction, defined as early diastolic myocardial velocity (Em) <0.08 m/s, was detected only in 3.2% of patients. Conclusions: The prevalence of LVH among hypertensive patients with normal ECG, free of diabetes and of CV diseases is low; moreover, patients with echocardiographic LVH presented LVMI values that identified mild LVH. Few cases of impaired diastolic function were registered. We suggest that in hypertensive patients with such characteristics the echocardiographic examination should be reserved to those who present with higher duration of hypertension.

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Relationship of electrocardiographic left ventricular hypertrophy to mortality and cardiovascular morbidity in high-risk patients

Abstract: In patients with CV disease simple, easily applicable ECG criteria for LVH identify a subset of individuals at particularly high risk for death and for heart failure.

Cited by 32 publications

References 32 publications

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

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

Impact of Diabetes Mellitus on Regression of Electrocardiographic Left Ventricular Hypertrophy and the Prediction of Outcome During Antihypertensive Therapy

Prevalence and predictors of left ventricular hypertrophy in patients with hypertension and normal electrocardiogram

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