title: Electrocardiographic left ventricular hypertrophy predicts arrhythmia and mortality in patients with ischemic cardiomyopathy.
abstract: OBJECTIVE
  The relatively low incidence of device-treated ventricular arrhythmias in patients with ischemic cardiomyopathy (ICM) who receive implantable cardioverter defibrillators (ICDs) for primary prevention makes improved risk stratification of ICM patients a priority. Although Cornell product (CP) ECG left ventricular hypertrophy (LVH) has been associated with increased mortality in hypertensive patients and population-based studies, whether CP LVH can improve risk stratification of high-risk ICM patients is unclear. The aim of this study is to examine if electrocardiographic LVH predicts mortality and incident ventricular arrhythmia in patients with ICM.
  
  
  METHODS
  All-cause mortality was examined in 317 patients with ICM and a history of non-sustained ventricular tachycardia (VT) who underwent electrophysiology testing. Incident VT and ventricular fibrillation (VF) were assessed in ICD recipients (n = 186). ECG LVH was defined by CP criteria: [(R (aVL) + S (V3)) + 6 mm in women] × QRS duration >2,440 mm ms.
  
  
  RESULTS
  During 3 years of follow-up, mortality was 20% (64 of 317) and death or incident VT or VF occurred in 35% of ICD recipients. CP LVH was associated with significantly greater 3-year mortality (28% vs 15%, p = 0.015) and 3-year mortality or incident VT/VF in ICD patients (48% vs 35%, p = 0.011). In Cox multivariate models, CP LVH was an independent predictor of mortality in all patients (hazard ratio (HR) 1.81, 95% confidence interval (CI) 1.11-2.97, p = 0.020) and of the composite endpoint of mortality or incident ventricular arrhythmia in ICD patients (HR 1.82, 95% CI 1.12-3.00, p = 0.016).
  
  
  CONCLUSIONS
  ECG LVH using CP criteria may enhance risk stratification in high-risk patients with ICM.
authors.affiliation: Greenberg Division of Cardiology, Weill Cornell Medical College, 525 East 68 St., New York, NY 10065, USA.
authors.forename: Seth R
authors.initials: SR
authors.lastname: Bender
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Friedman
authors.forename: Steven M
authors.initials: SM
authors.lastname: Markowitz
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Lerman
authors.forename: Peter M
authors.initials: PM
authors.lastname: Okin
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D009202:Cardiomyopathies / Q000401:mortality* / Q000503:physiopathology*; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000401:mortality* / Q000503:physiopathology*; D015994:Incidence; D008297:Male; D017202:Myocardial Ischemia / Q000401:mortality* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011322:Primary Prevention; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000401:mortality* / Q000503:physiopathology*; D014693:Ventricular Fibrillation / Q000401:mortality* / Q000503:physiopathology*