title: Thresholds in the relationship between mortality and left ventricular hypertrophy defined by electrocardiography.
abstract: BACKGROUND
  Electrocardiographic criteria for the diagnosis of left ventricular hypertrophy in current use were defined using autopsy results or echocardiography; criteria defined using mortality might be more clinically meaningful.
  
  
  METHODS
  Using data from Third National Health and Nutrition Examination Survey (NHANES III), we selected electrocardiographic measures that best differentiated those surviving at 5 years from those who did not. We identified voltage thresholds using regression techniques and then compared survival for subjects above and below the thresholds.
  
  
  RESULTS
  Cornell voltage, Cornell product, and Novacode estimate of left ventricular mass index were discriminative for mortality and had identifiable thresholds present in their relationships with mortality. Independent of systolic blood pressure, there were significant associations with 5-year mortality for Novacode index above threshold; hazard ratios were 1.58 for women and 1.27 for men, and for 5-year cardiovascular mortality were 1.78 for women and 2.34 for men.
  
  
  CONCLUSIONS
  Electrocardiographic criteria for left ventricular hypertrophy validated against mortality might be clinically useful.
authors.affiliation: Department of Medicine, Denver Health Medical Center, Denver, Colorado 80204-4507, USA.ehavrane@dhha.org
authors.forename: Edward P
authors.initials: EP
authors.lastname: Havranek
authors.forename: Caroline D B
authors.initials: CD
authors.lastname: Emsermann
authors.forename: Desiree N
authors.initials: DN
authors.lastname: Froshaug
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.forename: Mori J
authors.initials: MJ
authors.lastname: Krantz
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hanratty
authors.forename: Raymond O
authors.initials: RO
authors.lastname: Estacio
authors.forename: L Miriam
authors.initials: LM
authors.lastname: Dickinson
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
mesh_terms: D004562:Electrocardiography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000401:mortality*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013223:Statistics as Topic; D016019:Survival Analysis; D015996:Survival Rate; D014481:United States / Q000453:epidemiology