title: Left ventricular hypertrophy by ECG versus cardiac MRI as a predictor for heart failure.
abstract: To determine if there is a significant difference in the predictive abilities of left ventricular hypertrophy (LVH) detected by ECG-LVH versus LVH ascertained by cardiac MRI-LVH in a model similar to the Framingham Heart Failure Risk Score (FHFRS).
  
  
  
  This study included 4745 (mean age 61±10 years, 53.5% women, 61.7% non-whites) participants in the Multi-Ethnic Study of Atherosclerosis. ECG-LVH was defined using Cornell voltage product while MRI-LVH was derived from left ventricular mass. Cox proportional hazard regression was used to examine the association between ECG-LVH and MRI-LVH with incident heart failure (HF). Harrell's concordance C-index was used to estimate the predictive ability of the model when either ECG-LVH or MRI-LVH was included as one of its components.
  
  
  
  ECG-LVH was present in 291 (6.1%), while MRI-LVH was present in 499 (10.5%) of the participants. Both ECG-LVH (HR 2.25, 95% CI 1.38 to 3.69) and MRI-LVH (HR 3.80, 95% CI 1.56 to 5.63) were predictive of HF. The absolute risk of developing HF was 8.81% for MRI-LVH versus 2.26% for absence of MRI-LVH with a relative risk of 3.9. With ECG-LVH, the absolute risk of developing HF 6.87% compared with 2.69% for absence of ECG-LVH with a relative risk of 2.55. The ability of the model to predict HF was better with MRI-LVH (C-index 0.871, 95% CI 0.842 to 0.899) than with ECG-LVH (C-index 0.860, 95% CI 0.833 to 0.888) (p<0.0001).
  
  
  
  ECG-LVH and MRI-LVH are predictive of HF. Substituting MRI-LVH for ECG-LVH improves the predictive ability of a model similar to the FHFRS.
authors.affiliation: Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
authors.forename: Abdullahi O
authors.initials: AO
authors.lastname: Oseni
authors.affiliation: Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
authors.forename: Waqas T
authors.initials: WT
authors.lastname: Qureshi
authors.affiliation: Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
authors.forename: Mohamed F
authors.initials: MF
authors.lastname: Almahmoud
authors.affiliation: Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
authors.forename: Alain G
authors.initials: AG
authors.lastname: Bertoni
authors.affiliation: Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, Maryland, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.affiliation: Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
authors.forename: William G
authors.initials: WG
authors.lastname: Hundley
authors.affiliation: Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Joao A C
authors.initials: JA
authors.lastname: Lima
authors.affiliation: Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Herrington
authors.affiliation: Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.|Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D014481:United States / Q000453:epidemiology
keywords: ECG/electrocardiogram