title: Electrocardiographic versus echocardiographic left ventricular hypertrophy and sudden cardiac arrest in the community.
abstract: BACKGROUND
  Left ventricular hypertrophy (LVH) is associated with increased risk of sudden cardiac arrest (SCA). Whether LVH diagnosed by 12-lead ECG vs echocardiogram conveys identical or distinct risk information has not been previously evaluated.
  
  
  OBJECTIVE
  The purpose of this study was to compare the association between ECG vs echocardiographic LVH and SCA in the community.
  
  
  METHODS
  In a large, prospective population-based study (The Oregon Sudden Unexpected Death Study; population approximately 1 million), cases of SCA were compared to controls recruited from the same geographical area. The association between LVH and SCA was evaluated, specifically comparing LVH diagnosed by ECG vs echocardiogram.
  
  
  RESULTS
  Cases (n = 132, age 66.9 ± 13.5 years, 58.3% male) compared to controls (n = 211; age 66.2 ± 12 years, 59.2% male) were more likely to have both ECG LVH (12.1% vs 5.7%, P = .03) and echocardiographic LVH (35.0% vs 15.5%, P <.001). However, there was poor agreement between the tests (kappa statistic = 0.128). A large subgroup of patients with ECG LVH (57.1%) did not have echocardiographic LVH; conversely, 83.6% of patients with echocardiographic LVH did not have ECG LVH. In multivariate analysis, ECG LVH was significantly associated with SCA (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.1-6.0, P = .04). When echocardiographic LVH was added to the model, this association was only mildly attenuated (OR 2.4, 95% CI 1.0-6.0, P= .05), and echocardiographic LVH was also independently associated with SCA (OR 2.7, 95% CI 1.5-4.9, P = .001).
  
  
  CONCLUSIONS
  ECG and echocardiographic LVH may convey distinct risk information in patients with SCA, reflecting electrical vs anatomic remodeling. These findings have potential implications for SCA mechanisms and risk stratification.
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Kumar
authors.initials: K
authors.lastname: Narayanan
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Kyndaron
authors.initials: K
authors.lastname: Reinier
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Carmen
authors.initials: C
authors.lastname: Teodorescu
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Audrey
authors.initials: A
authors.lastname: Uy-Evanado
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Harpriya
authors.initials: H
authors.lastname: Chugh
authors.affiliation: Oregon Health and Science University, Portland, Oregon.
authors.forename: Karen
authors.initials: K
authors.lastname: Gunson
authors.affiliation: Oregon Health and Science University, Portland, Oregon.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Jui
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: sumeet.chugh@cshs.org.
authors.forename: Sumeet S
authors.initials: SS
authors.lastname: Chugh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control; D004562:Electrocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018570:Risk Assessment; D014463:Ultrasonography; D020257:Ventricular Remodeling
keywords: Arrhythmia; Electrophysiology; Sudden cardiac arrest