title: Relationship of electrocardiographic left ventricular hypertrophy to the presence of diastolic dysfunction.
abstract: BACKGROUND
  Left ventricular (LV) diastolic dysfunction (DD) is a known predictor of poor cardiovascular outcomes. Although ECG LV hypertrophy (LVH) is strongly associated with LV systolic dysfunction and heart failure, the relation of LV DD to ECG LVH is unclear.
  
  
  METHODS
  ECG LVH by Cornell product (CP) criteria was examined in a cohort of 185 patients who underwent both cardiac computed tomographic angiography and transthoracic echocardiography with complete evaluation of diastolic function. The presence of DD was determined via evaluation of mitral inflow velocities, tissue Doppler imaging, deceleration time, isovolumic relaxation time, pulmonary venous systolic: diastolic ratio, and left atrial enlargement.
  
  
  RESULTS
  Among the 185 patients (56% female, mean age 54.6 ± 15.6), 105 (57%) had DD. In univariate logistic regression analysis, patients in the upper quartile of CP (≥1595 mm·ms) had a >5-fold greater odds of DD (odds ratio [OR] 5.1, 95% confidence interval [CI] 2.2-11.7, P < 0.001). In alternative analyses treating CP as a continuous variable, each 1 SD increase in CP (664 mm·ms) was associated with an OR of 1.9 for DD (95% CI 1.3-2.7, P < 0.001). In multivariate logistic regression analyses adjusting for univariate predictors of DD, the highest quartile of CP remained associated with a 5.9-fold increased odds of DD (95% CI 2.3-15.4, P = 0.001), and each 1 SD of CP with a 1.7-fold increased odds of DD (95% CI 1.2-2.5, P = 0.005).
  
  
  CONCLUSIONS
  CP LVH is a strong predictor of DD, even after adjustment for other potential risk factors and ECG variables.
authors.affiliation: Greenberg Division of Cardiology.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Krepp
authors.forename: Fay
authors.initials: F
authors.lastname: Lin
authors.forename: James K
authors.initials: JK
authors.lastname: Min
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.forename: Peter M
authors.initials: PM
authors.lastname: Okin
mesh_terms: D015331:Cohort Studies; D003971:Diastole / Q000502:physiology*; D015150:Echocardiography, Doppler / Q000379:methods; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*
keywords: diastolic dysfunction; electrocardiography; heart failure; hypertrophy
references.citation: J Cardiovasc Pharmacol. 1987;10 Suppl 6:S135-40
references.pmid: 2485019
references.citation: N Engl J Med. 1990 May 31;322(22):1561-6
references.pmid: 2139921
references.citation: J Am Soc Echocardiogr. 2005 Dec;18(12):1440-63
references.pmid: 16376782
references.citation: Hypertension. 2009 Jan;53(1):28-34
references.pmid: 19015402
references.citation: J Am Soc Echocardiogr. 2009 Feb;22(2):107-33
references.pmid: 19187853
references.citation: J Int Med Res. 2011;39(3):772-9
references.pmid: 21819708
references.citation: N Engl J Med. 2004 May 20;350(21):2140-50
references.pmid: 15152059
references.citation: Arch Intern Med. 2011 Jun 27;171(12):1082-7
references.pmid: 21709107
references.citation: N Engl J Med. 2005 Apr 14;352(15):1539-49
references.pmid: 15753115
references.citation: N Engl J Med. 2006 Jul 20;355(3):260-9
references.pmid: 16855266
references.citation: Circulation. 2000 Oct 10;102(15):1788-94
references.pmid: 11023933
references.citation: Am Heart J. 1949 Feb;37(2):161-86
references.pmid: 18107386
references.citation: Am J Cardiol. 1987 Dec 14;60(17):85I-93I
references.pmid: 2961250
references.citation: Am J Med. 1983 Sep 26;75(3A):4-11
references.pmid: 6226193
references.citation: JAMA. 2006 Sep 13;296(10):1242-8
references.pmid: 16968848
references.citation: Curr Opin Cardiol. 2009 Mar;24(2):155-60
references.pmid: 19532102
references.citation: Hypertension. 2007 Nov;50(5):984-90
references.pmid: 17893425
references.citation: J Am Coll Cardiol. 2009 Jan 20;53(3):284-91
references.pmid: 19147047
references.citation: Curr Heart Fail Rep. 2006 Apr;3(1):5-13
references.pmid: 16684491
references.citation: J Am Coll Cardiol. 1992 Nov 1;20(5):1180-6
references.pmid: 1401620
references.citation: Circulation. 2012 Feb 14;125(6):782-8
references.pmid: 22261198
references.citation: Am Heart J. 2004 Nov;148(5):895-902
references.pmid: 15523324
references.citation: N Engl J Med. 2004 May 6;350(19):1953-9
references.pmid: 15128895
references.citation: J Am Coll Cardiol. 2007 Jun 12;49(23):2283-91
references.pmid: 17560294
references.citation: Ann Intern Med. 1970 Jun;72(6):813-22
references.pmid: 4247338
references.citation: Circulation. 2002 Feb 5;105(5):595-601
references.pmid: 11827925
references.citation: JAMA. 2003 Jan 8;289(2):194-202
references.pmid: 12517230
references.citation: Eur Heart J. 2008 Mar;29(6):741-7
references.pmid: 18204091
references.citation: Ann Intern Med. 1969 Jul;71(1):89-105
references.pmid: 4239887
references.citation: Ann Intern Med. 2007 Sep 4;147(5):311-9
references.pmid: 17785486
references.citation: Am J Cardiol. 2011 Dec 15;108(12):1760-6
references.pmid: 21907948
references.citation: J Cardiovasc Magn Reson. 2012 Oct 29;14:76
references.pmid: 23107451
references.citation: J Am Soc Echocardiogr. 2002 Feb;15(2):167-84
references.pmid: 11836492
references.citation: J Am Coll Cardiol. 2005 Oct 18;46(8):1606-13
references.pmid: 16226195
references.citation: Circulation. 1987 Mar;75(3):565-72
references.pmid: 2949887
references.citation: JAMA. 2004 Nov 17;292(19):2343-9
references.pmid: 15547161
references.citation: Circulation. 2004 Jun 29;109(25):3176-81
references.pmid: 15184280
references.citation: N Engl J Med. 2009 Oct 1;361(14):1329-38
references.pmid: 19723701
references.citation: Am J Cardiol. 1986 Feb 15;57(6):450-8
references.pmid: 2936235
references.citation: Circulation. 1967 Mar;35(3):583-602
references.pmid: 6021338