Electrocardiographic left ventricular hypertrophy in GUSTO IV ACS: an important risk marker of mortality in women.
OBJECTIVE
To examine the association of left ventricular hypertrophy (LVH) on admission electrocardiography with adverse outcomes in acute coronary syndrome (ACS) patients.


RESULTS
A total of 7443 non-ST-elevation ACS patients in Global Utilization of STrategies to Open occluded arteries (GUSTO) IV ACS trial had admission electrocardiograms analysed at a core laboratory. LVH [>or=20 mm Cornell voltage (LV voltage) (women) or >or=28 mm (men) plus strain patterns] was observed in 586 (7.9%) patients, and women accounted for 74%. LVH patients were also older and had more co-morbidities, ST-depression >or= 0.5 mm, elevated C-reactive protein and N-terminal pro-brain naturetic peptide (NT-proBNP), and lower troponin T. Invasive procedures occurred less often in LVH patients (cardiac catheterization: 31 vs. 38%, P = 0.001; percutaneous coronary intervention: 12 vs. 20%, P < 0.001). Mortality was significantly higher in patients with LVH (30 day: 5 vs. 3%, P = 0.046; 1 year: 14 vs. 7%, P < 0.001), whereas 30 day myocardial infarction (MI) and death/MI did not differ. After baseline adjustment including NT-proBNP, LVH remained associated with increased hazard of 1 year mortality in women, but not in men [P-interaction = 0.033; women: adjusted hazard ratio (LVH vs. no LVH): 1.42 (1.04-1.94), P = 0.029].


CONCLUSIONS
Electrocardiographic-LVH identifies an important subset of ACS patients with a higher risk of long-term mortality, particularly among women. These novel findings highlight opportunities to improve treatment and outcome among similar ACS patients.
Westerhout
Cynthia M
CM
Canadian VIGOUR Centre Research Group, 214 Heritage Medical Research Centre, University of Alberta, Edmonton, Alberta, Canada T6G 2S2. cindy.westerhout@ualberta.ca
Lauer
Michael S
MS
James
Stefan
S
Fu
Yuling
Y
Wallentin
Lars
L
Armstrong
Paul W
PW
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D012737:Sex Factors
D015415:Biomarkers