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Prognostic implications of left ventricular hypertrophy
B A Vakili1, P M Okin, R B Devereux
1Department of Medicine (Cardiovascular Medicine), Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
Insights
Left ventricular hypertrophy (LVH) significantly increases the risk of cardiovascular events and mortality. Early detection of LVH is crucial for managing adverse clinical outcomes.
Area of Science:
- Cardiology
- Clinical Medicine
- Epidemiology
Background:
- Left ventricular hypertrophy (LVH) is a common cardiac condition.
- The association between baseline LVH and adverse clinical events requires comprehensive review.
Purpose of the Study:
- To review the association between baseline left ventricular hypertrophy (LVH) and subsequent adverse clinical events.
- To synthesize evidence on the prognostic value of LVH.
Main Methods:
- Systematic review of 20 studies (48,545 participants) published between 1960 and 2000.
- Analysis of baseline electrocardiographic (ECG) or echocardiographic data on LVH.
- Assessment of cardiovascular morbidity and all-cause mortality.
Main Results:
- Baseline LVH prevalence varied: 16%-74% (echocardiographic) vs. 1%-44% (ECG).
- LVH increased cardiovascular morbidity risk (mean risk ratio: 2.3) and all-cause mortality risk (mean risk ratio: 2.5).
- Prognosis trended worse in women; findings were consistent across diverse populations.
Conclusions:
- LVH consistently predicts high risk for adverse outcomes, independent of covariates.
- No significant differences in risk were observed based on race, hypertension, or coronary disease.
- Detection of LVH is clinically important for risk stratification and management.
Background:
To date there has been no comprehensive review of the association between left ventricular hypertrophy (LVH) at baseline and subsequent adverse clinical events.
Methods:
A total of 20 studies (with 48,545 participants) published between January 1960 and January 2000, identified through MEDLINE and other sources, related baseline electrocardiographic (ECG) or echocardiographic data on LVH to subsequent cardiovascular morbidity and all-cause mortality.
Results:
The prevalence of baseline LVH was higher in echocardiographic studies than in ECG studies (16%-74% vs 1%-44%, respectively). The adjusted risk of future cardiovascular morbidity associated with baseline LVH ranged from 1.5 to 3.5, with a weighted mean risk ratio of 2.3 for all studies combined. The adjusted risk of all-cause mortality associated with baseline LVH ranged from 1.5 to 8.0, with a weighted mean risk ratio of 2.5 for all studies combined. There was a trend toward a worse prognosis among women with baseline LVH compared with men. These findings persisted in the various population and ethnic groups studied.
Conclusion:
With the exception of one study in dialysis patients, LVH consistently predicted high risk, independently of examined covariates, with no clear difference in relation to race, presence or absence of hypertension or coronary disease, or between clinical and epidemiologic samples. These results clarify the strong relation between LVH and adverse outcome and emphasize the clinical importance of its detection.