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Prognostic impact of baseline and serial changes in electrocardiographic left ventricular hypertrophy in resistant

Gil Fernando Salles1, Claudia Regina Lopes Cardoso, Roberto Fiszman

  • 1Department of Internal Medicine, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brasil. gilsalles@hucff.ufrj.br <gilsalles@hucff.ufrj.br>

American Heart Journal
|May 4, 2010
PubMed

Insights

Electrocardiographic left ventricular hypertrophy (ECG-LVH) in resistant hypertension (RH) predicts cardiovascular events and mortality. Reducing ECG-LVH markers improves outcomes, suggesting targeted treatment can enhance prognosis in RH patients.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Clinical Electrophysiology

Background:

  • The prognostic significance of electrocardiographic left ventricular hypertrophy (ECG-LVH) in patients with resistant hypertension (RH) remains largely uncharacterized.
  • Understanding ECG-LVH's role is crucial for predicting cardiovascular outcomes in this high-risk population.

Purpose of the Study:

  • To determine the prognostic value of baseline and serial changes in ECG-LVH criteria for cardiovascular morbidity and mortality in patients with RH.
  • To investigate specific ECG-LVH criteria as predictors of various cardiovascular events and mortality.

Main Methods:

  • A cohort of 552 RH patients underwent baseline and follow-up ECG assessments for three LVH criteria: Sokolow-Lyon, Cornell voltage, and Cornell voltage-duration product.
  • Primary endpoints included a composite of fatal/nonfatal cardiovascular events and all-cause/cardiovascular mortality. Secondary endpoints were strokes and coronary heart disease (CHD) events.
  • Multiple Cox regression analysis was used to evaluate time-varying ECG-LVH as a predictor of subsequent events.

Main Results:

  • Over a median 4.8-year follow-up, 70 deaths and 109 cardiovascular events occurred.
  • Baseline Cornell voltage and product were independent predictors of the composite endpoint and mortality, while Sokolow-Lyon voltage was not.
  • Reductions in all ECG-LVH criteria were associated with reduced cardiovascular event risk; specifically, a 1-SD reduction in Sokolow-Lyon voltage lowered risk by 35%, and prevention/regression of Cornell product LVH lowered risk by 40%.

Conclusions:

  • Both baseline and changes over time in ECG-LVH are significant predictors of cardiovascular morbidity and mortality in RH patients.
  • Antihypertensive strategies aimed at preventing or regressing ECG-LVH may offer a pathway to improved clinical outcomes in this population.
Abstract

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