title: Association of heart failure hospitalizations with combined electrocardiography and echocardiography criteria for left ventricular hypertrophy.
abstract: BACKGROUND
  The value of performing echocardiography in hypertensive patients with electrocardiographic left ventricular hypertrophy (LVH) is uncertain.
  
  
  METHODS
  Baseline echo- and electrocardiographic data and cardiovascular events over 4.8 years study treatment were assessed in 922 hypertensive patients in the Losartan Intervention For Endpoint reduction in hypertension echocardiography substudy. Patients were grouped according to presence of LVH on both electrocardiogram (ECG) and echocardiogram (n = 515), only on ECG (n = 172), only on echocardiogram (n = 135), or on none tests (n = 100). LVH was diagnosed by Sokolow Lyon and Cornell product criteria by electrocardiography and as LV mass index >116 g/m(2) in men and >104 g/m(2) in women by echocardiography.
  
  
  RESULTS
  Patients with LVH on both tests were older, had higher systolic blood pressure and LV mass, lower LV systolic function, and included more patients with aortic regurgitation, albuminuria, and history of ischemic heart disease (all P < 0.05). Incidence of combined myocardial infarction, stroke, or cardiovascular death did not differ between groups. Incidence of hospitalization for heart failure was 5.3 and 2.6 times higher in patients with LVH on both tests compared to patients with LVH on ECG or echocardiogram only (P < 0.01). In Cox regression, LVH on both tests predicted hospitalization for heart failure (hazard ratio 4.29 (95% confidence interval 1.26-14.65), P = 0.020) independent of other covariates including study treatment allocation and history of ischemic heart disease.
  
  
  CONCLUSIONS
  Our results suggest that combining LVH assessment on a single ECG and echocardiogram provides a simple tool for additional heart failure risk stratification in asymptomatic high-risk hypertensive patients.
authors.affiliation: Institute of Medicine, University of Bergen, Bergen, Norway. eva.gerdts@med.uib.no
authors.forename: Eva
authors.initials: E
authors.lastname: Gerdts
authors.forename: Peter M
authors.initials: PM
authors.lastname: Okin
authors.forename: Kurt
authors.initials: K
authors.lastname: Boman
authors.forename: Kristian
authors.initials: K
authors.lastname: Wachtell
authors.forename: Markku S
authors.initials: MS
authors.lastname: Nieminen
authors.forename: Björn
authors.initials: B
authors.lastname: Dahlöf
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D019808:Losartan / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents; D019808:Losartan