Left ventricular hypertrophy (LVH) diagnosed by electrocardiography (ECG-LVH) and
echocardiography (echo-LVH) are independently associated with an increased risk of
cardiovascular disease (CVD) events. However, it is unknown if ECG-LVH retains its
predictive properties independent of LV anatomy. We compared the risk of CVD associated
with ECG-LVH and echo-LVH in 4,076 participants (41% men, 86% white) from the Cardiovascular
Health Study, who were free of baseline CVD. ECG-LVH was defined with Minnesota ECG
Classification criteria from baseline ECG data. Echo-LVH was defined by gender-specific
LV mass values normalized to body surface area (male: >102 g/m2; female: >88 g/m2). ECG-LVH was detected in 144 participants (3.5%) and echo-LVH in 430 participants
(11%). Over a median follow-up of 10.6 years, 2,274 CVD events occurred. In a multivariate
Cox regression analysis adjusted for common CVD risk factors, ECG-LVH (hazard ratio
[HR] 1.84, 95% CI 1.51 to 2.24) and echo-LVH (HR 1.35, 95% CI 1.19 to 1.54) were associated
with an increased risk for CVD events. The association between ECG-LVH and CVD events
was not substantively altered with further adjustment for echo-LVH (HR 1.76, 95% CI
1.45 to 2.15). In conclusion, the association of ECG-LVH with CVD events is not dependent
on echo-LVH. This finding provides support to the concept that ECG-LVH is an electrophysiological
marker with predictive properties independent of LV anatomy.
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References
- Left ventricular mass and risk of stroke in an elderly cohort. The Framingham Heart Study.JAMA. 1994; 272: 33-36
- Left ventricular mass and incidence of coronary heart disease in an elderly cohort. The Framingham Heart Study.Ann Intern Med. 1989; 110: 101-107
- Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy.Circulation. 1994; 90: 1786-1793
- Probability of stroke: a risk profile from the Framingham Study.Stroke. 1991; 22: 312-318
- Short-term predictors of incident stroke in older adults. The Cardiovascular Health Study.Stroke. 1996; 27: 1479-1486
- Profile for estimating risk of heart failure.Arch Intern Med. 1999; 159: 1197-1204
- Association of electrocardiographic and imaging surrogates of left ventricular hypertrophy with incident atrial fibrillation: MESA (Multi-Ethnic Study of Atherosclerosis).J Am Coll Cardiol. 2014; 63: 2007-2013
- Diagnostic and prognostic utility of electrocardiography for left ventricular hypertrophy defined by magnetic resonance imaging in relationship to ethnicity: the Multi-Ethnic Study of Atherosclerosis (MESA).Am Heart J. 2010; 159: 652-658
- The Cardiovascular Health Study: design and rationale.Ann Epidemiol. 1991; 1: 263-276
- Major electrocardiographic abnormalities in persons aged 65 years and older (the Cardiovascular Health Study). Cardiovascular Health Study Collaborative Research Group.Am J Cardiol. 1992; 69: 1329-1335
- The Minnesota Code Manual of Electrocardiographic Findings: Standards and Procedures for Measurement and Classification.2nd ed. Springer, London2010
- Echocardiographic design of a multicenter investigation of free-living elderly subjects: the Cardiovascular Health Study.J Am Soc Echocardiogr. 1992; 5: 63-72
- Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings.Am J Cardiol. 1986; 57: 450-458
- Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.Eur Heart J Cardiovasc Imaging. 2015; 16: 233-270
- Methods of assessing prevalent cardiovascular disease in the Cardiovascular Health Study.Ann Epidemiol. 1995; 5: 270-277
- Surveillance and ascertainment of cardiovascular events. The Cardiovascular Health Study.Ann Epidemiol. 1995; 5: 278-285
- Assessment of cerebrovascular disease in the Cardiovascular Health Study.Ann Epidemiol. 1993; 3: 504-507
- A linear rank test for use when the main interest is in differences in cure rates.Biometrics. 1989; 45: 899-904
- Framingham score and LV mass predict events in young adults: CARDIA study.Int J Cardiol. 2014; 172: 350-355
- Evaluation by the Minnesota Code of the electrocardiographic changes in patients over 70.Cardiologia. 1983; 28: 619-624
- The Romhilt-Estes left ventricular hypertrophy score and its components predict all-cause mortality in the general population.Am Heart J. 2015; 170: 104-109
- Electrocardiographic changes improve risk prediction in asymptomatic persons age 65 years or above without cardiovascular disease.J Am Coll Cardiol. 2014; 64: 898-906
- Association of electrocardiogram abnormalities and incident heart failure events.Am Heart J. 2014; 167: 869-875.e3
- AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology.J Am Coll Cardiol. 2009; 53: 992-1002
- Computer simulation of ECG manifestations of left ventricular electrical remodeling.J Electrocardiol. 2012; 45: 630-634
- Effect of changes in left ventricular anatomy and conduction velocity on the QRS voltage and morphology in left ventricular hypertrophy: a model study.J Electrocardiol. 2010; 43: 200-208
- Left ventricular mass and hypertrophy by echocardiography and cardiac magnetic resonance: the multi-ethnic study of atherosclerosis.Echocardiography. 2014; 31: 12-20
Article info
Publication history
Published online: March 19, 2016
Accepted:
March 1,
2016
Received in revised form:
March 1,
2016
Received:
December 22,
2015
Footnotes
This Manuscript was prepared using CHS Research Materials obtained from the NHLBI Biologic Specimen and Data Repository Information Coordinating Center and does not necessarily reflect the opinions or views of the CHS or the NHLBI. Dr. Leigh is supported with grant T32 HL076132 from National Institutes of Health, Bethesda, MD.
See page 1834 for disclosure information.
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