Abstract MP55: Electrocardiographic versus Echocardiographic Left Ventricular Hypertrophy in Prediction of Congestive Heart Failure in the Elderly
Background: Left ventricular hypertrophy (LVH) is an established risk factor for congestive heart failure (HF) and is a component of the Framingham HF Risk Score (FHFRS). Whether LVH detected by electrocardiogram (ECG-LVH) is equally predictive of HF as LVH detected by echocardiography (Echo-LVH) is unclear.
Methods: This analysis included 4,543 participants (85% white; 41% male) aged 65 years or older from the Cardiovascular Health Study (CHS) who were free of HF and major intraventricular conduction defects at baseline. Adjudicated incident HF was identified during a median follow-up of 12 years. ECG-LVH was defined by the sex-specific Cornell voltage criteria. Echo-LVH was defined from the observed left ventricular (LV) mass compared with the sex-specific predicted LV mass values. Cox proportional hazard regression was used to compute hazard ratios (HR) and 95% confidence intervals (95%CI) for the association between ECG-LVH and Echo-LVH with incident HF, separately. Models were adjusted for age, sex, race, education, income, smoking status, systolic blood pressure, diabetes, body mass index, total cholesterol, HDL-cholesterol, aspirin, statins, antihypertensive medications, log (hs-CRP), and history of coronary heart disease. Harrell’s concordance indices were calculated for the FHFRS with inclusion of ECG-LVH and Echo-LVH, separately.
Results: At baseline, 168 participants had ECG-LVH and 78 had Echo-LVH. A total of 30% (1,380 out of 4,543) incident HF events occurred during follow up. In separate multivariable adjusted models, both ECG-LVH and Echo-LVH were predictive of incident HF (ECG-LVH: HR=1.4, 95%CI=1.1, 1.8; Echo-LVH: HR=1.7, 95%CI=1.2, 2.5). The ability of the FHFRS to predict HF was similar when ECG-LVH (C-index: 0.772, 95%CI=0.726, 0.815) and Echo-LVH (C-index: 0.771, 95%CI=0.726, 0.814) were included into the model separately.
Conclusion: Both LVH-ECG and Echo-LVH are predictive of incident HF and can be used interchangeably in heart failure risk prediction models.
Author Disclosures: M. Almahmoud: None. E. Soliman: None. W. Qureshi: None. W. O'Neal: None.
- © 2015 by American Heart Association, Inc.