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Updated: Sep 8, 2025
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Left ventricular hypertrophy in the automatic electrocardiogram report and mortality risk
Gabriela Miana Paixão1, Nathalia Coelho de Castro Nunes1, Milena Soriano Marcolino1
1Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais,Belo Horizonte, Brazil; Departament of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Insights
The Glasgow score for Left Ventricular Hypertrophy (LVH) on ECGs can predict mortality. Higher LVH-Glasgow scores in primary care patients were linked to an increased risk of all-cause death.
Area of Science:
- Cardiology
- Digital Health
- Public Health
Background:
- Left Ventricular Hypertrophy (LVH) causes myocardial changes detectable by ECG, but current criteria have low sensitivity compared to echocardiography.
- Automated ECG analysis offers large-scale potential, yet studies on the prognostic value of automatically detected LVH are limited.
Purpose of the Study:
- To assess the association between the Glasgow program's LVH score from ECGs and overall mortality in a Brazilian primary care population.
- To determine if automated ECG-derived LVH is a predictor of mortality.
Main Methods:
- Analysis of digital ECGs from the CODE cohort (2010-2017) in patients over 18 years old.
- Utilized the University of Glasgow Automated ECG Interpretation program for LVH scoring (definite ≥6.3, probable 5.0-6.3, possible 4.0-5.0).
- Cox regression analysis, adjusted for age, sex, and comorbidities, evaluated the relationship between LVH score and mortality.
Main Results:
- The study included over 1.3 million patients, with an 18.5% prevalence of abnormal LVH-Glasgow scores (≥4.0).
- During a median follow-up of 3.47 years, the all-cause mortality rate was 2.68%.
- Definite LVH (HR 1.64) and probable LVH (HR 1.18) showed significantly higher risks of overall mortality, with possible LVH also associated with increased risk (HR 1.09).
Conclusions:
- The LVH-Glasgow score derived from automated ECG analysis serves as a valuable prognostic tool.
- Elevated LVH-Glasgow scores are independently associated with increased all-cause mortality in this primary care cohort.
Introduction:
Left ventricular hypertrophy (LVH) is associated with complex structural changes in the myocardium, which may alter the electrocardiogram (ECG). The ECG is the initial test for patients with suspected heart disease. Electrocardiographic criteria for LVH diagnosis have a low sensitivity compared to the echocardiogram (ECHO). The advent of tele-ECG and the availability of automatic analysis systems have made the large-scale use of electrocardiography possible. However, there are only a few studies on the prevalence and prognosis of LVH automatically detected in the ECG.
Objective:
To evaluate the association between the Glasgow program score for LVH in the ECG and overall mortality in an electronic cohort of primary care patients in Brazil.
Methods:
Patients from the CODE (Clinical Outcomes in Digital Electrocardiology) cohort, older than 18 years, who underwent digital ECG recording from 2010 to 2017, were included. The University of Glasgow Automated ECG Interpretation program was used to analyze the ECGs. ECG LVH was classified into definite LVH if the LVH-Glasgow score was≥6.3, probable LVH if the score was between 5.0 and 6.3, possible LVH if the score was between 4.0 and 5.0, and no LVH if the score was <4.0. To assess the relationship between the LVH-Glasgow score and mortality, Cox regression adjusted for age, sex, and comorbidities was used.
Results:
The CODE database included 1,558,415 patients, with 1,389,331 patients over 18 years old. Technically unsatisfactory ECGs that could compromise the analysis were excluded. The Glasgow program automatically excludes the diagnosis of LVH if LBBB, WPW, or pacemaker rhythm have been detected before the tests for LVH are undertaken. The prevalence of an abnormal LVH-Glasgow score (≥4.0) was 18.5 %. At a median follow-up of 3.47 years, the general population's all-cause mortality rate was 2.68 %. After multivariate adjustment, the presence of definite LVH had a higher risk of overall mortality (95 % CI; HR 1.64 (1.59-1.69)); probable LVH (95 % CI; HR 1.18 (1. 14-1.23)) and possible LVH (95 % CI; HR 1.09 (1.05-1.13)) were also associated with increasing risk of death.
Conclusions:
The LVH-Glasgow score can be a prognostic tool in ECG analysis. In this population, a higher score was associated with a higher risk of overall mortality.
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