Circulation, Vol 90, 1786-1793, Copyright © 1994 by American Heart Association
D Levy, M Salomon, RB D'Agostino, AJ Belanger and WB Kannel
BACKGROUND: During the past half-century, the ECG has been used extensively
for the diagnosis of left ventricular hypertrophy. Persons with ECG
evidence of left ventricular hypertrophy are at increased risk for the
development of cardiovascular disease. METHODS AND RESULTS: Subjects from
the Framingham Heart Study with ECG evidence of left ventricular
hypertrophy were eligible for this investigation if they were free of
cardiovascular disease and did not have complete bundle- branch block or
Wolff-Parkinson-White syndrome. Logistic regression analyses of pooled
biennial examinations were used to determine risk for cardiovascular
disease as a function of baseline voltage (sum of R wave in aVL plus S wave
in V3) and repolarization and as a function of serial changes in these ECG
features of hypertrophy. The eligible sample consisted of 274 men (mean
age, 60 years) and 250 women (mean age, 64 years) who contributed 2660
person-examinations. During follow- up, there were 269 new cardiovascular
events. Compared with subjects in the first quartile of voltage at
baseline, the age-adjusted odds ratio for cardiovascular disease among
subjects in the fourth quartile was 3.08 (95% confidence interval [CI],
1.87 to 5.07) in men and 3.29 (95% CI, 1.78 to 6.09) in women. Compared
with a normal repolarization pattern, the presence of severe repolarization
abnormalities was associated with an age-adjusted odds ratio of 5.84 (95%
CI, 3.55 to 9.62) in men and 2.47 (95% CI, 1.38 to 4.42) in women. Subjects
with a serial decline in voltage were at lower risk for cardiovascular
disease than were those with no serial change (men: odds ratio after
adjusting for age and baseline voltage, 0.46; 95% CI, 0.26 to 0.84; women:
odds ratio, 0.56; 95% CI, 0.30 to 1.04). In contrast, those with a serial
increase in voltage were at greater risk for cardiovascular disease (men:
odds ratio, 1.86; 95% CI, 1.14 to 3.03; women: odds ratio, 1.61; 95% CI,
0.91 to 2.84). Compared with those with no serial change, an improvement in
repolarization was associated with a marginally significant reduction in
cardiovascular risk in men (odds ratio after adjusting for age and baseline
repolarization, 0.45; 95% CI, 0.20 to 1.01). Worsening of repolarization
was associated with increased risk for cardiovascular disease in both sexes
(men: odds ratio, 1.89; 95% CI, 1.05 to 3.40; women: odds ratio, 2.02; 95%
CI, 1.07 to 3.81). CONCLUSIONS: The results of this investigation suggest
that regression of ECG features of left ventricular hypertrophy confers an
improvement in risk for cardiovascular disease, whereas serial worsening
imposes increased risk. The benefits to be derived from regression of left
ventricular hypertrophy must be confirmed in other clinical settings.
ARTICLES
Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy
Framingham Heart Study, MA 01701.
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R. J. Gibbons, K. Chatterjee, J. Daley, J. S. Douglas, S. D. Fihn, J. M. Gardin, M. A. Grunwald, D. Levy, B. W. Lytle, R. A. O'Rourke, et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina) J. Am. Coll. Cardiol., June 1, 1999; 33(7): 2092 - 2197. [Full Text] [PDF]
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F. G. Dunn and M. A. Pfeffer Left Ventricular Hypertrophy in Hypertension N. Engl. J. Med., April 22, 1999; 340(16): 1279 - 1280. [Full Text]
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P. A. Thurmann, P. Kenedi, A. Schmidt, S. Harder, and N. Rietbrock Influence of the Angiotensin II Antagonist Valsartan on Left Ventricular Hypertrophy in Patients With Essential Hypertension Circulation, November 10, 1998; 98(19): 2037 - 2042. [Abstract] [Full Text] [PDF]
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A. W. Haider, M. G. Larson, E. J. Benjamin, and D. Levy Increased left ventricular mass and hypertrophy are associated with increased risk for sudden death J. Am. Coll. Cardiol., November 1, 1998; 32(5): 1454 - 1459. [Abstract] [Full Text] [PDF]
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P. Verdecchia, G. Schillaci, C. Borgioni, A. Ciucci, R. Gattobigio, I. Zampi, G. Reboldi, and C. Porcellati Prognostic Significance of Serial Changes in Left Ventricular Mass in Essential Hypertension Circulation, January 13, 1998; 97(1): 48 - 54. [Abstract] [Full Text] [PDF]
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 M. K. Hong, J. Vossoughi, G. S. Mintz, R. D. Kauffman, R. F. Hoyt Jr, J. F. Cornhill, E. E. Herderick, M. B. Leon, and J. M. Hoeg Altered Compliance and Residual Strain Precede Angiographically Detectable Early Atherosclerosis in Low-Density Lipoprotein Receptor Deficiency Arterioscler Thromb Vasc Biol, October 1, 1997; 17(10): 2209 - 2217. [Abstract] [Full Text]
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 D.-J. Choi, W. J. Koch, J. J. Hunter, and H. A. Rockman Mechanism of beta -Adrenergic Receptor Desensitization in Cardiac Hypertrophy Is Increased beta -Adrenergic Receptor Kinase J. Biol. Chem., July 4, 1997; 272(27): 17223 - 17229. [Abstract] [Full Text] [PDF]
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R. B. Devereux Do Antihypertensive Drugs Differ in Their Ability to Regress Left Ventricular Hypertrophy? Circulation, April 15, 1997; 95(8): 1983 - 1985. [Full Text]
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J. S. Gottdiener, D. J. Reda, B. M. Massie, B. J. Materson, D. W. Williams, and R. J. Anderson Effect of Single-Drug Therapy on Reduction of Left Ventricular Mass in Mild to Moderate Hypertension: Comparison of Six Antihypertensive Agents Circulation, April 15, 1997; 95(8): 2007 - 2014. [Abstract] [Full Text]
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S. G. Sheps and E. D. Frohlich Limited Echocardiography for Hypertensive Left Ventricular Hypertrophy Hypertension, February 1, 1997; 29(2): 560 - 563. [Full Text]
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 J. R. Gonzalez-Juanatey, J. M. Garca-Acuna, M. V. Fernandez, A. A. Cendon, V. C. Fuentes, J. B. Garcia-Bengoechea, and M. G. de la Pena INFLUENCE OF THE SIZE OF AORTIC VALVE PROSTHESES ON HEMODYNAMICS AND CHANGE IN LEFT VENTRICULAR MASS: IMPLICATIONS FOR THE SURGICAL MANAGEMENT OF AORTIC STENOSIS J. Thorac. Cardiovasc. Surg., August 1, 1996; 112(2): 273 - 280. [Abstract] [Full Text]
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W. B. Kannel Blood Pressure as a Cardiovascular Risk Factor: Prevention and Treatment JAMA, May 22, 1996; 275(20): 1571 - 1576. [Abstract] [PDF]
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R. B. Devereux Regression of Left Ventricular Hypertrophy: How and Why? JAMA, May 15, 1996; 275(19): 1517 - 1518. [Abstract] [PDF]
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