Journal of Electrocardiology
Volume 41, Issue 4 , Pages 342-350, July 2008

Thresholds in the relationship between mortality and left ventricular hypertrophy defined by electrocardiography☆

  • Edward P. Havranek, MD

      Affiliations

    • Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA
    • Colorado Health Outcomes Program, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA
    • Corresponding Author InformationCorresponding author. Denver Health Medical Center #0960, Denver, CO 80204-4507, USA. Tel.: +1 303 436 5499; fax: +1 303 436 7739.
    • ,
  • Caroline D.B. Emsermann, MS

      Affiliations

    • Colorado Health Outcomes Program, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA
    • ,
  • Desiree N. Froshaug, BS

      Affiliations

    • Colorado Health Outcomes Program, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA
    • ,
  • Frederick A. Masoudi, MD MSPH

      Affiliations

    • Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA
    • Colorado Health Outcomes Program, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA
    • ,
  • Mori J. Krantz, MD

      Affiliations

    • Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA
    • Colorado Health Outcomes Program, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA
    • ,
  • Rebecca Hanratty, MD

      Affiliations

    • Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA
    • Colorado Health Outcomes Program, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA
    • ,
  • Raymond O. Estacio, MD

      Affiliations

    • Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA
    • Colorado Health Outcomes Program, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA
    • ,
  • L. Miriam Dickinson, PhD

      Affiliations

    • Colorado Health Outcomes Program, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA
    • ,
  • John F. Steiner, MD, MPH

      Affiliations

    • Colorado Health Outcomes Program, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA

Received 13 February 2007; accepted 15 November 2007. published online 17 March 2008.

Abstract 

Background

Electrocardiographic criteria for the diagnosis of left ventricular hypertrophy in current use were defined using autopsy results or echocardiography; criteria defined using mortality might be more clinically meaningful.

Methods

Using data from Third National Health and Nutrition Examination Survey (NHANES III), we selected electrocardiographic measures that best differentiated those surviving at 5 years from those who did not. We identified voltage thresholds using regression techniques and then compared survival for subjects above and below the thresholds.

Results

Cornell voltage, Cornell product, and Novacode estimate of left ventricular mass index were discriminative for mortality and had identifiable thresholds present in their relationships with mortality. Independent of systolic blood pressure, there were significant associations with 5-year mortality for Novacode index above threshold; hazard ratios were 1.58 for women and 1.27 for men, and for 5-year cardiovascular mortality were 1.78 for women and 2.34 for men.

Conclusions

Electrocardiographic criteria for left ventricular hypertrophy validated against mortality might be clinically useful.

Keywords: Left ventricular hypertrophy, Electrocardiography, Mortality, Survival, NHANES

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☆ National Heart, Lung, and Blood Institute grant U01 HL079160 (Bethesda, Maryland, USA) and Health Resources and Services Administration Administrative Unit grant HP00054 5 D12 (Rockville, Maryland, USA).

PII: S0022-0736(07)00923-5

doi:10.1016/j.jelectrocard.2007.11.006

Journal of Electrocardiology
Volume 41, Issue 4 , Pages 342-350, July 2008

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