ECG left ventricular hypertrophy as a risk predictor of sudden cardiac death
Kimmo Porthan1, Tuomas Kenttä2, Teemu J Niiranen3
1Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland.
Insights
Electrocardiogram (ECG) left ventricular hypertrophy (LVH) criteria, particularly the combined Sokolow-Lyon and Cornell measures, predict sudden cardiac death (SCD) risk. This composite is the preferred dichotomous ECG measure for assessing SCD risk.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Diagnostics
Background:
- Electrocardiographic (ECG) left ventricular hypertrophy (LVH) is a known risk factor for cardiovascular events.
- Limited data exists on the prognostic value of specific ECG LVH criteria for sudden cardiac death (SCD).
Purpose of the Study:
- To evaluate the association between various ECG LVH criteria and SCD risk.
- To identify the most effective ECG LVH measures for predicting SCD.
Main Methods:
- Assessed traditional (Sokolow-Lyon, Cornell, RaVL) and a novel (Peguero-Lo Presti) ECG LVH voltage criteria in 5730 participants from the Health 2000 Survey.
- Analyzed relationships between LVH criteria and SCD using Cox regression models.
- Calculated population-attributable fractions for LVH criteria.
Main Results:
- Over a mean follow-up of 12.5 years, 134 SCDs occurred.
- Continuous LVH variables (except RaVL) were associated with SCD.
- The composite of Sokolow-Lyon and Cornell criteria, used dichotomously, was significantly associated with SCD (HR 1.82) and had a significant population-attributable fraction (11.0%).
Conclusions:
- Sokolow-Lyon, Cornell, and Peguero-Lo Presti ECG voltage criteria are associated with SCD risk when analyzed continuously.
- The composite of Sokolow-Lyon and Cornell voltages is the preferred dichotomous ECG measure for SCD risk assessment.
Background:
Electrocardiographic (ECG) left ventricular hypertrophy (LVH) is an established risk factor for cardiovascular events. However, limited data is available on the prognostic values of different ECG LVH criteria specifically to sudden cardiac death (SCD). Our goal was to assess relationships of different ECG LVH criteria to SCD.
Methods:
Three traditional and clinically useful (Sokolow-Lyon, Cornell, RaVL) and a recently proposed (Peguero-Lo Presti) ECG LVH voltage criteria were measured in 5730 subjects in the Health 2000 Survey, a national general population cohort study. Relationships between LVH criteria, as well as their selected composites, to SCD were analyzed with Cox regression models. In addition, population-attributable fractions for LVH criteria were calculated.
Results:
After a mean follow-up of 12.5 ± 2.2 years, 134 SCDs had occurred. When used as continuous variables, all LVH criteria except for RaVL were associated with SCD in multivariable analyses. When single LVH criteria were used as dichotomous variables, only Cornell was significant after adjustments. The dichotomous composite of Sokolow-Lyon and Cornell was also significant after adjustments (hazard ratio for SCD 1.82, 95% confidence interval 1.20-2.70, P = 0.006) and was the only LVH measure that showed statistically significant population-attributable fraction (11.0%, 95% confidence interval 1.9-19.2%, P = 0.019).
Conclusions:
Sokolow-Lyon, Cornell, and Peguero-Lo Presti ECG, but not RaVL voltage, are associated with SCD risk as continuous ECG voltage LVH variables. When SCD risk assessment/adjustment is performed using a dichotomous ECG LVH measure, composite of Sokolow-Lyon and Cornell voltages is the preferred option.
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