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The Romhilt-Estes left ventricular hypertrophy score and its components predict all-cause mortality in the general
E Harvey Estes1, Zhu-Ming Zhang2, Yabing Li2
1Department of Community and Family Medicine, Duke University Medical Center, Durham, NC.
Insights
The Romhilt-Estes (R-E) score, used for left ventricular hypertrophy (LVH), effectively predicts mortality risk. This electrocardiogram (ECG) tool and its components offer valuable insights into adverse clinical outcomes.
Area of Science:
- Cardiology
- Medical Diagnostics
- Public Health
Background:
- Electrocardiogram (ECG) criteria for left ventricular hypertrophy (LVH) are increasingly recognized as predictors of adverse clinical outcomes.
- The predictive ability of these ECG criteria for clinical outcomes requires further exploration.
Purpose of the Study:
- To investigate the association between the Romhilt-Estes (R-E) score for LVH and all-cause mortality.
- To examine the predictive value of individual components of the R-E score for mortality.
- To assess the association between changes in the R-E score and mortality risk.
Main Methods:
- Analysis of 14,984 participants from the ARIC study with baseline ECG data (1987-1989).
- Calculation of the Romhilt-Estes (R-E) LVH score and its components.
- Ascertainment of all-cause mortality up to December 2010.
- Use of Cox proportional hazard models to analyze associations between R-E score (baseline and change) and mortality.
Main Results:
- A median follow-up of 21.7 years revealed 4,549 all-cause mortality events.
- Increasing baseline R-E scores and increases in R-E score over time were associated with higher mortality risk.
- Four of the six R-E score components (P-terminal force, QRS amplitude, LV strain, intrinsicoid deflection) were predictive of mortality.
Conclusions:
- The Romhilt-Estes (R-E) score, beyond its use for LVH detection, serves as a valuable tool for predicting adverse clinical outcomes.
- Specific ECG components within the R-E score demonstrate differential predictive power for mortality.
Background:
The same electrocardiographic (ECG) criteria that have been used for detection of left ventricular hypertrophy (LVH) have recently been recognized as predictors of adverse clinical outcomes, but this predictive ability is inadequately explored and understood.
Methods:
A total of 14,984 participants from the ARIC study were included in this analysis. Romhilt-Estes (R-E) LVH score was measured from the automatically processed baseline (1987-1989) ECG data. All-cause mortality was ascertained up to December 2010. Cox proportional hazard models were used to examine the association between baseline R-E score, overall and each of its 6 individual components separately, with all-cause mortality. The associations between change in R-E score between baseline and first follow-up visit with mortality were also examined.
Results:
During a median follow-up of 21.7 years, 4,549 all-cause mortality events occurred during follow-up. In multivariable-adjusted models, increasing levels of the R-E score was associated with increasing risk of mortality both as a baseline finding and as a change between the baseline and the first follow-up visit. Of the 6 ECG components of the score, 4 were predictive of all-cause mortality (P-terminal force, QRS amplitude, LV strain, and intrinsicoid deflection), whereas 2 of the components were not (left axis deviation and prolonged QRS duration). Differences in the strengths of the associations between the individual components of the score and mortality were observed.
Conclusions:
The R-E score, traditionally used for detection of LVH, could be used as a useful tool for predication of adverse outcomes.
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