Electrocardiographic left ventricular hypertrophy and coronary artery disease: clinical, hemodynamic, and angiographic correlates

Abstract

The present investigation defines left ventricular function and coronary artery anatomy in a group of patients with electrocardiographic evidence of left ventricular hypertrophy (ECG-LVH) and documented coronary artery disease. The ECG-LVH group consisted of 57 patients who were matched with age/sex controls. All patients were evaluated because of angina pectoris and no patient had a history or ECG evidence of prior myocardial infarction. The duration of symptoms in both groups was not significantly different. Hypertension (75% vs 30%), congestive heart failure (25% vs 0%), and cardiomegaly (49% vs 4%) were significantly more frequent in the ECG-LVH group. The ECG-LVH group demonstrated greater left ventricular dysfunction as evident in a higher left ventricular end-diastolic pressures (20 ± 8 vs 12 ± 9 mm. Hg), end-diastolic volumes (80 ± 28 vs 66 ± 22 ml./m. 2) and lower ejection fractions (0.55 ± 0.20 vs 0.64 ± 0.17). The severity of the coronary artery disease as reflected by the number of vessels involved and total coronary score revealed no significant group differences. The ECG-LVH group was further divided based on ECG-left atrial enlargement (LAE). Such evidence of LAE was associated with a higher frequency (p < 0.05) of cardiomegaly (59% vs 29%) and a significantly (p < 0.01) lower ejection fraction (0.50 ± 18 vs 0.64 ± 0.17), as well as higher frequency (p < 0.005) of an abnormal contractile pattern (76% vs 37%). Evaluation of the ECG-LVH group with the Romhilt-Estes point-score for the LVH or the presence of abnormal ST segments and T waves, revealed no significant difference in left ventricular function. Patients with hypertension, compared to those with no hypertension, revealed no differences in LVH point-score or left ventricular function; however, main left coronary artery disease was significantly (p < 0.05) more frequent in the ECG-LVH subgroup with no hypertension (29% vs 7%). It is concluded that ECG-LVH in patients with coronary artery disease defines a group of patients with increased frequency of left ventricular dysfunction, especially when associated with LAE. Furthermore, such ECG findings in the presence of ischemic heart disease defines a subgroup of patients with an excessive frequency of main left coronary artery disease. These observations may in part explain the poor prognosis previously described from epidemiological studies of patients with ECG-LVH and coronary artery disease.