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Published on: September 25, 2017
Prognostic Value of Electrocardiographic Left Ventricular Hypertrophy on Cardiovascular Risk in a Non-Hypertensive
Kentaro Tanaka1, Fumitaka Tanaka1, Toshiyuki Onoda2
1Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
Insights
Left ventricular hypertrophy on ECG (ECG-LVH) predicts cardiovascular events in non-hypertensive adults. This finding offers improved risk assessment beyond traditional factors.
Area of Science:
- Cardiology
- Electrocardiography
- Preventive Medicine
Background:
- Left ventricular hypertrophy detected by electrocardiography (ECG-LVH) is linked to cardiovascular events (CVEs).
- Previous research primarily focused on hypertensive individuals, leaving the risk in non-hypertensive populations less clear.
Purpose of the Study:
- To investigate the association between ECG-LVH and incident CVEs in a non-hypertensive general population.
- To determine if ECG-LVH provides additional prognostic value for CVE risk prediction.
Main Methods:
- A cohort of 4,927 non-hypertensive adults (≥40 years) without prior CVEs was followed.
- ECG-LVH was identified using Sokolow-Lyon (SL) voltage, Cornell voltage (CV), or Cornell voltage product (CP) criteria.
Main Results:
- During 9.8 years, 5.4% experienced a CVE.
- ECG-LVH significantly increased CVE risk (HR=1.77) independent of obesity, dyslipidemia, diabetes, or optimal blood pressure.
- ECG-LVH improved CVE risk reclassification in models like the Framingham 10-year risk score.
Conclusions:
- ECG-LVH is an independent predictor of CVEs in individuals without hypertension.
- ECG-LVH offers valuable prognostic information for cardiovascular risk assessment in this population.
Background:
The appearance of left ventricular hypertrophy on 12-lead electrocardiography (ECG-LVH) has been clarified to be associated with the risk of incidence of cardiovascular events (CVEs) in hypertensive individuals and the general population, but not enough in non-hypertensive individuals.
Methods:
A total of 4,927 non-hypertensive individuals ≥40 years of age who were free of CVE in the general population were followed for the incidence of CVE. ECG-LVH was defined according to criteria of the Sokolow-Lyon (SL) voltage, Cornell voltage (CV), or Cornell voltage product (CP).
Results:
During the average 9.8 ± 2.0 years of follow-up, 267 individuals (5.4%) had their first CVE. The hazard ratio (HR) for the incidence of CVE after full adjustment by potential confounders significantly increased in the individuals with ECG-LVH by any criteria of the SL voltage, CV, and CP (HR = 1.77, P < 0.001) compared to those with no ECG-LVH. This association was also significant in individuals without any of obesity, dyslipidemia, and diabetes mellitus or those with systolic blood pressure (BP) <120 mm Hg and diastolic BP <80 mm Hg. Furthermore, ECG-LVH by each criteria provided the reclassification improvement for the CVE risk prediction model by the Framingham 10-year risk score (the net reclassification improvement = 0.17-0.22, each P value < 0.010).
Conclusions:
In the absence of hypertension, ECG-LVH parameters are associated with the increased risk of developed CVEs independent of the established risk factors and provide the additional prognostic value in an assessment of the CVE risk using the traditional risk factors.
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