Complementary value of ECG and echocardiographic left ventricular hypertrophy for prediction of adverse outcomes in the general population. Issue 3 (March 2021)

• Record Type: Journal Article
• Authors: Du, Zhi; Xing, Liying; Ye, Ning; Lin, Min; Sun, Yingxian
• Is Part Of: Journal of hypertension. Volume 39:Issue 3(2021)
• Page Start: 548
• Page End: 555
• Publication Date: 2021-03
• Subjects: cardiovascular disease -- ECG -- echocardiography -- left ventricular hypertrophy -- mortality; Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/HJH.0000000000002652
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Supplemental Digital Content is available in the text Abstract : Objective: To investigate whether ECG left ventricular hypertrophy (ECG-LVH) has prognostic value independent of echocardiography LVH (Echo-LVH). Methods: Participants ( N = 9744, mean age, 53.81 ± 10.49 years and 45.5% male) from the Northeast China Rural Cardiovascular Health Study were included. Associations between Echo-LVH (sex-specific left ventricular mass normalized to BSA) and ECG-LVH (diagnosed using the Cornell-voltage duration product) and adverse outcomes were evaluated using Cox regression. The value of ECG-LVH for predicting adverse events was evaluated by reclassification and discrimination analyses. Results: Median follow-up was 4.65 years; 563 participants developed incident stroke or coronary heart disease (CHD) and 402 died. Compared with participants without either condition, those with both Echo-LVH and ECG-LVH had a significantly increased risk of incident stroke or CHD (hazard ratio, 2.42; 95% confidence interval, 1.82–3.22) and mortality (2.58; 1.85–3.60). ECG-LVH remained an independent risk factors for both outcomes when ECG-LVH and Echo-LVH were included in the model as separate variables [incident stroke or CHD (1.43; 1.14–1.79); mortality (1.41; 1.08–1.84)]. Reclassification and discrimination analyses indicated ECG-LVH addition could improve the conventional model for predicting adverse outcomes within 4 years. These relationships persisted after excluding participants with cardiovascular disease history or taking antihypertension drugs or upon applying other ECG-LVH and Echo-LVH diagnostic criteria. Conclusion: Our study provides strong evidence that ECG-LVH is associated with adverse outcomes, independent of Echo-LVH. Clinically, ECG-LVH could be considered as a consequential factor, especially in those with Echo-LVH. These findings have potential clinical relevance for risk stratification.