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Left ventricular hypertrophy and mortality--results from the Framingham Study
1Department of Medicine, Evans Memorial Research Foundation, Boston University School of Medicine, Mass.
Insights
Left ventricular hypertrophy (LVH), detected by ECG, echocardiogram, or X-ray, strongly predicts lethal atherosclerotic disease and cardiovascular events. Reversing LVH offers benefits, especially when addressing associated risk factors like hypertension.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Left ventricular hypertrophy (LVH) is a significant cardiac condition.
- Its prognostic implications require thorough investigation across different detection methods.
- Long-term data is crucial for understanding LVH's impact on cardiovascular outcomes.
Purpose of the Study:
- To evaluate the prognostic significance of LVH using ECG, echocardiogram (ECHO), and X-ray.
- To assess the association between LVH and cardiovascular morbidity and mortality.
- To explore the reversibility of LVH and its impact on cardiovascular risk.
Main Methods:
- Analysis of 36-year follow-up data from the Framingham Study.
- Assessment of LVH using electrocardiogram (ECG), echocardiogram (ECHO), and X-ray.
- Statistical analysis of cardiovascular events, morbidity, and mortality in relation to LVH presence and severity.
Main Results:
- LVH, by any method (ECG, ECHO, X-ray), is a potent predictor of lethal atherosclerotic disease.
- Cardiovascular risk increases progressively with left ventricular muscle mass.
- ECG- and X-ray-determined LVH independently predict cardiovascular events, with combined presence indicating higher risk.
- Cardiac failure and stroke show the highest risk ratios with ECG-LVH, though coronary disease is the most common sequela.
- LVH is reversible, with anatomical LVH showing greater reversibility and benefit.
Conclusions:
- LVH is a critical indicator of advanced, lethal atherosclerotic disease.
- Reversal of LVH, particularly anatomical, improves cardiovascular outcomes.
- LVH risk is modulated by associated factors like hypertension, glucose intolerance, lipids, and smoking, highlighting the importance of risk factor modification.
Abstract:
Data on the prognostic implications of left ventricular hypertrophy (LVH) in the Framingham Study based on routine ECG, echocardiogram (ECHO) and X-ray determination with 36 years of follow-up indicate that LVH has emerged as a powerful indicator of rapidly evolving lethal atherosclerotic disease, whether determined by ECG, ECHO or X-ray. Cardiovascular morbidity and mortality increase progressively with left ventricular muscle mass from lowest to highest values. The ECG and X-ray versions of LVH each independently contribute to the risk of cardiovascular events; each adds to the risk associated with the other, and those with both are at greater risk than those with either alone. Risk ratios associated with ECG-LVH are substantial and are greatest for cardiac failure and stroke, but coronary disease is the commonest and most lethal sequela. LVH is reversible, the anatomical variety more so than ECG-LVH, and reversal of this toward normal appears to confer greater benefit for the anatomical rather than the ECG manifestation of LVH. The risk of cardiovascular disease associated with LVH is not uniform, varying widely depending not only on whether there is concomitant ECG and anatomical evidence of hypertrophy but also on the associated hypertension, glucose intolerance, lipid profile and cigarette smoking habit. This suggests that there is much to be gained in correcting those associated risk factors which also promote the development of LVH.