Left ventricular hypertrophy patterns and prognosis. Experience postinfarction in the Coronary Drug Project.

Abstract

Electrocardiographic evidence of left ventricular hypertrophy (ECG-LVH), defined only by elevated R wave amplitudes in appropriate leads of the resting ECG, was ascertained among 2,760 survivors of myocardial infarction who had been randomized into the placebo-treated group of the Coronary Drug Project. The entry ECG findings were related to the subsequent three-year mortality. Of 2,760 men, 186 (6.7%) had ECG-LVH amplitude criteria in the baseline ECG when taken after at least three months survival (average, 36 months) from the last myocardial infarction. Three-year mortality in men with ECG-LVH was almost twice that in men without ECG-LVH (22.6% vs 12.1%; P = 0.0002) when the "effect" of all other variables on mortality was ignored. However, when the relationship between baseline ECG-LVH and subsequent mortality was adjusted, using a multivariate analysis, for other electrocardiographic and clinical findings, elevated R amplitude itself had no significantly independent prognostic importance. The prognostic importance of ECG-LVH was largely explained by coexisting repolarization abnormalities, although ECG-LVH plus abnormal ST-segment and T wave findings had a less favorable prognosis than ST-segment and T wave abnormalities alone. ECG-LVH by R wave amplitude criteria in the absence of abnormal ST-segment and T wave findings was unrelated to prognosis in these postinfarct patients.