Relationship of electrocardiographic left ventricular hypertrophy to mortality and cardiovascular morbidity in high-risk patients

Abstract

Background: The prognostic significance of left ventricular hypertrophy (LVH) identified by simple electrocardiographic (ECG) criteria in high-risk patients with established cardiovascular (CV) diseases is not clearly understood.

Design and methods: The Heart Outcomes Prevention Evaluation (HOPE) trial was a randomized trial, which evaluated the effects of ramipril and of vitamin E on major CV outcomes in 9541 men and women aged 55 years or older with a history of coronary artery disease, stroke, peripheral vascular disease or diabetes mellitus with at least one additional CV risk factor. Patients were followed for an average of 4.5 years. We evaluated the association between simple ECG criteria for LVH and the risk for major vascular events, for CV and all-cause mortality and for heart failure.

Results: Electrocardiographic LVH was present in 793 (8.3%) HOPE study participants. Of these, 19.0% sustained a major CV event (MI, stroke or CV death), 15.6% died and 6.1% developed heart failure compared with 15.6%, 10.8% and 2.9% respectively of those without ECG-LVH (P = 0.0023; P < 0.0001 and P < 0.0001). In multivariate analysis ECG-LVH was an independent predictor of CV and all-cause death and of heart failure.

Conclusions: In patients with CV disease simple, easily applicable ECG criteria for LVH identify a subset of individuals at particularly high risk for death and for heart failure.