Abstract 3818: Combined Echocardiographic Left Ventricular Hypertrophy and Quantitative Electrocardiographic Strain Pattern Predict New-Onset Heart Failure: The Strong Heart Study
Background: Echocardiographic left ventricular hypertrophy (Echo-LVH) and quantitative measures of ST depression on the ECG (ECG-STD) in the lateral precordial leads have each been demonstrated to predict new-onset heart failure (HF). However, the predictive value for HF of combining Echo-LVH and ECG-STD has not been examined.
Methods: ECGs and echocardiograms were examined in 2057 American Indian participants in the second Strong Heart Study examination with no history of HF. The absolute magnitude of ST segment deviation was measured by computer to the nearest 5 μV in leads V5 and V6 and the upper quartile of abnormal values (≤ −5 μV) was taken as the abnormal value. Echo-LVH was defined by indexed LV mass >116 g/m2 in men and >104 in women.
Results: During mean follow-up of 5.7±1.4 years, HF developed in 77 participants (3.7%). In univariate Cox analyses, both Echo-LVH (HR 4.82, 95% CI 2.89–8.03) and ECG-STD (HR 4.09, 95% CI 2.59–6.45) predicted new HF; both variables remained significant predictors after adjustment for age, diabetes, pulse pressure, serum creatinine, fibrinogen, c-reactive protein, log urine albumin/creatinine ratio and LV systolic function (Echo-LVH, HR 2.05, 95% CI 1.18–3.56 and ECG-STD, HR 2.44,, 95% CI 1.49–3.97). The combination of Echo-LVH and ECG-STD improved risk stratification compared with either alone, with the presence of both Echo-LVH and ECG-STD associated with the highest risk of HF (Table⇓). 6-year HF event rates were 19.9% in participants with both Echo-LVH and ECG-STD abnormal, 5.9% in those with either Echo-LVH or ECG-STD and only 1.9% in those with neither Echo-LVH or ECG-STD (p<0.0001).
Conclusions: The combination of Echo-LVH and ECG-STD in the lateral precordial leads is strongly associated with development of new HF, independent of baseline LV systolic function and other risk factors for HF. These findings further support the value of combining Echo and ECG to improve risk stratification.