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Long-term prognosis after acute myocardial infarction in patients with left ventricular hypertrophy on the
S Behar1, H Reicher-Reiss, E Abinader
1Neufeld Cardiac Research Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Insights
Electrocardiographic left ventricular hypertrophy (LVH) in acute myocardial infarction (AMI) survivors is linked to significantly higher mortality. Identifying LVH may help target patients needing closer follow-up and early testing post-discharge.
Area of Science:
- Cardiology
- Clinical Medicine
- Diagnostic Electrocardiography
Background:
- Left ventricular hypertrophy (LVH) is a common finding in cardiovascular disease.
- Its prevalence and prognostic significance in acute myocardial infarction (AMI) survivors require further elucidation.
Purpose of the Study:
- To determine the prevalence of electrocardiographic left ventricular hypertrophy (LVH) in hospital survivors of acute myocardial infarction (AMI).
- To assess the association between electrocardiographic LVH and short-term and long-term mortality in AMI survivors.
- To identify patient characteristics associated with electrocardiographic LVH.
Main Methods:
- Retrospective analysis of 4,720 hospital survivors of AMI.
- Electrocardiographic assessment for left ventricular hypertrophy (LVH).
- Statistical analysis to determine prevalence, associated factors, and mortality risk.
Main Results:
- The prevalence of electrocardiographic LVH was 6.1% among AMI survivors.
- LVH was associated with increased age, prior myocardial infarction, angina, and hypertension.
- Patients with LVH exhibited higher rates of congestive heart failure and significantly increased 1- and 5-year mortality rates (19.7% vs. 8.7% at 1 year, 46.6% vs. 26.2% at 5 years).
- Adjusted analysis showed a 1.51-fold increased risk of 1-year and 5-year mortality in patients with LVH.
Conclusions:
- Electrocardiographic LVH in AMI survivors is a significant predictor of increased short- and long-term mortality.
- Patients with LVH post-AMI may benefit from early noninvasive testing and intensive follow-up.
- Identification of LVH on discharge ECG can aid in risk stratification for AMI survivors.
Abstract:
Among 4,720 consecutive hospital survivors from acute myocardial infarction (AMI) treated in 13 coronary care units between July 1981 and August 1983, the estimated prevalence of electrocardiographic left ventricular (LV) hypertrophy was 6.1%. The prevalence of electrocardiographic LV hypertrophy increased with age and was higher in patients with previous myocardial infarction, angina and systemic hypertension. Mean age of patients with electrocardiographic LV hypertrophy was 67.2 vs 61.4 years in counterparts free of electrocardiographic LV hypertrophy. Patients with electrocardiographic LV hypertrophy had a higher rate of congestive heart failure on admission, or developing during their stay in coronary care units. The 1- and 5-year mortality rates were 19.7 and 46.6% among patients with electrocardiographic LV hypertrophy versus 8.7 and 26.2%, respectively (p less than 0.001) in patients without this finding. The covariate-adjusted odds ratio of 1-year mortality was 1.88 for the presence of electrocardiographic LV hypertrophy when age alone was adjusted for, and 1.51 (90% confidence interval, 1.09 to 2.10) when multiple covariate adjustment was undertaken. After multiple covariate adjustment for 5-year mortality after discharge, the relative risk associated with electrocardiographic LV hypertrophy was 1.51 (90% confidence interval, 1.26 to 1.80). The results of the present study showed that the presence of electrocardiographic LV hypertrophy on the discharge electrocardiogram of survivors from AMI is associated with a 1.5-fold increase of short- and long-term mortality. Patients with electrocardiographic LV hypertrophy, potentially at an increased post-discharge risk, may be candidates for early noninvasive testing and more intensive follow-up after recovering from AMI.