title: Accuracy and prognostic significance of electrocardiographic markers of left ventricular hypertrophy in a general population: findings from the Pressioni Arteriose Monitorate E Loro Associazioni population.
abstract: OBJECTIVE
  We assessed the value of three electrocardiographic (ECG) voltage criteria in detecting left ventricular hypertrophy (LVH) and in predicting cardiovascular events and all-cause mortality in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) population.
  
  
  METHODS
  At entry, 1549 individuals (age 50 ± 13 years, 50.5% men) underwent diagnostic tests including laboratory investigations, 24-h ambulatory blood pressure monitoring, and standard ECG and echocardiography.
  
  
  RESULTS
  The sensitivity of ECG criteria for LVH was lowest for Sokolow-Lyon voltage (1.5 and 0.78%), intermediate for Cornell voltage (20.5 and 19.0%), and highest for RaVL wave amplitude (26.0 and 36.2%), independently of whether left ventricular mass was indexed to body surface area or height, respectively. After adjustment for age, sex, night-time SBP, low-density lipoprotein and high-density lipoprotein cholesterol, serum glucose, BMI, smoking, and previous cardiovascular events, only Cornell voltage index [hazard ratio for a 0.1  mV increase: 1.050, 95% confidence interval (CI): 1.017-1.083, P < 0.003] predicted an increased risk of cardiovascular events as well as all-cause mortality. Furthermore, when the categorical relationship between ECG-graphic LVH and cardiovascular outcomes was investigated in multiple models, only LVH identified by the Cornell voltage index remained an independent predictor of cardiovascular events (hazard ratio = 2.466, CI 1.459-4.168, P = 0.0008) and all-cause deaths (hazard ratio = 2.984, CI 1.380-6.449, P = 0.005).
  
  
  CONCLUSIONS
  Despite the limited sensitivity of ECG voltage criteria in detecting LVH, our results show that Cornell voltage index may improve cardiovascular risk stratification in a general population independently of several confounding factors.
authors.affiliation: aDepartment of Health Science, University of Milano-Bicocca bIstituto Auxologico Italiano IRCCS cDepartment of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore Policlinico dIRCCS Multimedica, Sesto San Giovanni, Milano, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Cuspidi
authors.forename: Rita
authors.initials: R
authors.lastname: Facchetti
authors.forename: Michele
authors.initials: M
authors.lastname: Bombelli
authors.forename: Carla
authors.initials: C
authors.lastname: Sala
authors.forename: Guido
authors.initials: G
authors.lastname: Grassi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000737:chemistry; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000503:physiopathology; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000473:pathology*; D007558:Italy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D016277:Ventricular Function, Left
chemical_list: D000959:Antihypertensive Agents; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL