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Left ventricular hypertrophy and risk of cardiac failure: insights from the Framingham Study
W B Kannel1, D Levy, L A Cupples
1Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Massachusetts 02118.
Insights
Left ventricular hypertrophy detected by electrocardiogram (ECG-LVH) significantly increases congestive heart failure (CHF) risk, especially with repolarization changes. Hypertension is a key factor in both conditions.
Area of Science:
- Cardiology
- Medical Diagnostics
- Epidemiology
Background:
- Congestive heart failure (CHF) is a significant public health concern.
- Cardiac hypertrophy is a known precursor to CHF.
- Longitudinal studies are crucial for understanding disease progression and risk factors.
Purpose of the Study:
- To examine the incidence of CHF in relation to cardiac hypertrophy.
- To determine the predictive value of electrocardiogram (ECG) and radiographic findings for CHF.
- To identify predisposing factors for cardiac hypertrophy and CHF.
Main Methods:
- Analysis of over 30 years of follow-up data from the Framingham Study.
- Assessment of cardiac hypertrophy using electrocardiogram (ECG) and radiography.
- Correlation of ECG patterns, including left ventricular hypertrophy (ECG-LVH), with CHF incidence.
- Inclusion of echocardiographic data (ECHO-LVH) for comparison.
Main Results:
- Hypertension was the primary risk factor for both cardiac hypertrophy and CHF.
- ECG-LVH significantly increased CHF risk (2-5 fold) in men and women aged 35-64.
- ECG-LVH with repolarization changes independently predicted CHF risk in both sexes and across age groups.
- ECG-LVH was a stronger predictor of CHF than radiographic heart enlargement.
- Echocardiographic LVH was more prevalent in CHF patients than ECG-LVH.
Conclusions:
- Cardiac hypertrophy, particularly when indicated by ECG-LVH with repolarization abnormalities, is a strong predictor of CHF.
- ECG-LVH is a more potent indicator of CHF risk than radiographic findings.
- Hypertension is a critical underlying factor contributing to cardiac hypertrophy and subsequent CHF.
Abstract:
The incidence of congestive heart failure (CHF), derived from more than 30 years of follow-up, is examined by electrocardiogram (ECG) and radiography in relation to cardiac hypertrophy. Cardiac failure occurred in 485 of 5,209 subjects participating in the Framingham Study. Hypertension was the dominant predisposing factor for both cardiac hypertrophy and cardiac failure. The ECG pattern of left ventricular hypertrophy (ECG-LVH) heralded serious cardiovascular disease of all varieties, but risk ratios were two- to fivefold greater for the development of CHF in men and women (ages 35-64 years) than for any other sequelae. Risk of CHF in those with ECG-LVH exceeded that for unrecognized ECG patterns at myocardial infarction (ECG-MI). The ECG pattern of left ventricular hypertrophy, characterized by increased voltage unaccompanied by a repolarization abnormality, carried a decreased risk, chiefly reflecting the severity of coexistent hypertension. The independent contribution of ECG-LVH with accompanying repolarization changes to the risk of CHF was equal in the two sexes and persisted with advancing age. The ECG pattern of left ventricular hypertrophy was more strongly associated with occurrence of CHF than was radiographic enlargement, and contributed to the risk of CHF (taking radiographic heart size into account). Echocardiographic evidence of LVH (ECHO-LVH) was more common in subjects with CHF than was ECG-LVH, occurring in 63% of women and 77% of men with CHF, and LVH was the most frequently observed echocardiographic finding. Cardiac hypertrophy was found to be an ominous harbinger of cardiac failure, particularly when it was manifested on an ECG with repolarization abnormality.(ABSTRACT TRUNCATED AT 250 WORDS)