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Electrocardiographic left ventricular hypertrophy predicts arrhythmia and mortality in patients with ischemic

Seth R Bender1, Daniel J Friedman, Steven M Markowitz

  • 1Greenberg Division of Cardiology, Weill Cornell Medical College, 525 East 68 St., New York, NY 10065, USA.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
|February 23, 2012
PubMed

Insights

Cornell product (CP) ECG left ventricular hypertrophy (LVH) identifies high-risk patients with ischemic cardiomyopathy (ICM) who may benefit from implantable cardioverter defibrillators (ICDs). This ECG marker predicts mortality and ventricular arrhythmias in these patients.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Diagnostics

Background:

  • Ischemic cardiomyopathy (ICM) patients receiving implantable cardioverter defibrillators (ICDs) for primary prevention have low event rates, necessitating improved risk stratification.
  • Cornell product (CP) electrocardiogram (ECG) left ventricular hypertrophy (LVH) is linked to mortality in hypertensive populations, but its role in ICM risk stratification is not well-defined.

Purpose of the Study:

  • To investigate whether ECG-defined LVH predicts mortality and incident ventricular arrhythmias in patients with ICM.
  • To determine if CP LVH can improve risk stratification in high-risk ICM patients.

Main Methods:

  • Examined all-cause mortality in 317 ICM patients with prior non-sustained ventricular tachycardia (VT).
  • Assessed incident VT and ventricular fibrillation (VF) in 186 ICD recipients.
  • Defined ECG LVH using CP criteria: [(R aVL + S V3) + 6 mm in women] × QRS duration > 2440 ms.

Main Results:

  • Over 3 years, mortality was 20%. CP LVH was associated with significantly higher 3-year mortality (28% vs. 15%, p=0.015).
  • In ICD recipients, CP LVH predicted a composite of mortality or incident VT/VF (48% vs. 35%, p=0.011).
  • CP LVH independently predicted mortality (HR 1.81) and the composite endpoint in ICD patients (HR 1.82).

Conclusions:

  • ECG LVH, identified by CP criteria, may enhance risk stratification for high-risk ICM patients.
  • This ECG marker could aid in identifying ICM patients who would benefit most from ICD therapy.
Abstract

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