Wesley T O'Neal1, Mohamed F Almahmoud2, Waqas T Qureshi2, Elsayed Z Soliman3. 1. Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Electronic address: woneal@wakehealth.edu. 2. Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. 3. Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Abstract
INTRODUCTION: It is unclear whether left ventricular hypertrophy (LVH) detected by electrocardiography (ECG-LVH) is equally predictive of heart failure as LVH detected by echocardiography (echo-LVH). METHODS: This analysis included 4,008 white participants (41% men) aged 65 years or older from the Cardiovascular Health Study who were free of stroke and major intraventricular conduction defects. ECG-LVH was defined by the Cornell criteria from baseline ECG data and echo-LVH was calculated from baseline echocardiography measurements. Cox regression was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between ECG-LVH and echo-LVH and adjudicated incident stroke events, separately. Harrell's concordance indices (C-index) were calculated for the Framingham Stroke Risk Score with inclusion of ECG-LVH and echo-LVH, separately. RESULTS: ECG-LVH was detected in 136 (3.4%) participants and echo-LVH was present in 208 (5.2%) participants. Over a median follow-up of 13 years, a total of 769 (19%; incidence rate = 15.4 per 1000 person-years) strokes occurred. In a multivariable Cox regression analysis adjusted for stroke risk factors and potential confounders, ECG-LVH (HR = 1.68; 95% CI = 1.23, 2.28) and echo-LVH (HR = 1.58; 95% CI = 1.17, 2.14) were associated with an increased risk of stroke. Similar values were obtained for the C-index when either ECG-LVH (C-index = .786) or echo-LVH (C-index = .786) were included in the Framingham Stroke Risk Score. CONCLUSION: ECG-LVH and echo-LVH are able to be used interchangeably in stroke risk scores.
INTRODUCTION: It is unclear whether left ventricular hypertrophy (LVH) detected by electrocardiography (ECG-LVH) is equally predictive of heart failure as LVH detected by echocardiography (echo-LVH). METHODS: This analysis included 4,008 white participants (41% men) aged 65 years or older from the Cardiovascular Health Study who were free of stroke and major intraventricular conduction defects. ECG-LVH was defined by the Cornell criteria from baseline ECG data and echo-LVH was calculated from baseline echocardiography measurements. Cox regression was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between ECG-LVH and echo-LVH and adjudicated incident stroke events, separately. Harrell's concordance indices (C-index) were calculated for the Framingham Stroke Risk Score with inclusion of ECG-LVH and echo-LVH, separately. RESULTS: ECG-LVH was detected in 136 (3.4%) participants and echo-LVH was present in 208 (5.2%) participants. Over a median follow-up of 13 years, a total of 769 (19%; incidence rate = 15.4 per 1000 person-years) strokes occurred. In a multivariable Cox regression analysis adjusted for stroke risk factors and potential confounders, ECG-LVH (HR = 1.68; 95% CI = 1.23, 2.28) and echo-LVH (HR = 1.58; 95% CI = 1.17, 2.14) were associated with an increased risk of stroke. Similar values were obtained for the C-index when either ECG-LVH (C-index = .786) or echo-LVH (C-index = .786) were included in the Framingham Stroke Risk Score. CONCLUSION: ECG-LVH and echo-LVH are able to be used interchangeably in stroke risk scores.
Authors: L P Fried; N O Borhani; P Enright; C D Furberg; J M Gardin; R A Kronmal; L H Kuller; T A Manolio; M B Mittelmark; A Newman Journal: Ann Epidemiol Date: 1991-02 Impact factor: 3.797
Authors: C D Furberg; T A Manolio; B M Psaty; D E Bild; N O Borhani; A Newman; B Tabatznik; P M Rautaharju Journal: Am J Cardiol Date: 1992-05-15 Impact factor: 2.778
Authors: D G Ives; A L Fitzpatrick; D E Bild; B M Psaty; L H Kuller; P M Crowley; R G Cruise; S Theroux Journal: Ann Epidemiol Date: 1995-07 Impact factor: 3.797
Authors: B M Psaty; L H Kuller; D Bild; G L Burke; S J Kittner; M Mittelmark; T R Price; P M Rautaharju; J Robbins Journal: Ann Epidemiol Date: 1995-07 Impact factor: 3.797
Authors: J M Gardin; N D Wong; W Bommer; H S Klopfenstein; V E Smith; B Tabatznik; D Siscovick; S Lobodzinski; H Anton-Culver; T A Manolio Journal: J Am Soc Echocardiogr Date: 1992 Jan-Feb Impact factor: 5.251
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