Relationship of electrocardiographic left ventricular hypertrophy to mortality and cardiovascular morbidity in high-risk patients.
BACKGROUND
The prognostic significance of left ventricular hypertrophy (LVH) identified by simple electrocardiographic (ECG) criteria in high-risk patients with established cardiovascular (CV) diseases is not clearly understood.


METHODS
The Heart Outcomes Prevention Evaluation (HOPE) trial was a randomized trial, which evaluated the effects of ramipril and of vitamin E on major CV outcomes in 9541 men and women aged 55 years or older with a history of coronary artery disease, stroke, peripheral vascular disease or diabetes mellitus with at least one additional CV risk factor. Patients were followed for an average of 4.5 years. We evaluated the association between simple ECG criteria for LVH and the risk for major vascular events, for CV and all-cause mortality and for heart failure.


RESULTS
Electrocardiographic LVH was present in 793 (8.3%) HOPE study participants. Of these, 19.0% sustained a major CV event (MI, stroke or CV death), 15.6% died and 6.1% developed heart failure compared with 15.6%, 10.8% and 2.9% respectively of those without ECG-LVH (P = 0.0023; P < 0.0001 and P < 0.0001). In multivariate analysis ECG-LVH was an independent predictor of CV and all-cause death and of heart failure.


CONCLUSIONS
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.
Lonn
Eva
E
Department of Medicine, McMaster University, Hamilton, Ontario, Canada. lonnem@mcmaster.ca
Mathew
James
J
Pogue
Janice
J
Johnstone
David
D
Danisa
Kola
K
Bosch
Jackie
J
Baird
Michael
M
Dagenais
Gilles
G
Sleight
Peter
P
Yusuf
Salim
S
D000368:Aged; D002170:Canada; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality*; D004311:Double-Blind Method; D004562:Electrocardiography; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors