Abstract
Objective: Left ventricular hypertrophy (LVH) is a strong risk factor for cardiovascular events. ECG is the most widely used method for LVH detection. Despite the abundance of ECG LVH criteria, their prognostic values have been compared in only a few studies, and little has been known about how gender modifies the prognostic value LVH. We assessed the relationship between ECG LVH and incident cardiovascular events in the general population. Design and method: Several ECG LVH criteria were measured in 3059 women and 2456 men participating in the Health 2000 Study, a national general population survey. Association between ECG LVH and cardiovascular events were analyzed with Cox proportional hazards models adjusted for age, body mass index, systolic blood pressure, current smoking, use of antihypertensive medication, history of hypercholesterolemia and history of diabetes mellitus. We used a composite end point that included cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, percutaneous coronary intervention, and coronary artery bypass surgery. Results: ECG LVH was more prevalent in women than in men when measured with Cornell-based criteria but less prevalent or non-different when measured with other criteria. 334 women suffered a cardiovascular event during a follow-up of 10.6 ± 2.3 years while 328 men had a cardiovascular event during a follow-up of 10.4 ± 2.6 years. The association between ECG LVH and events showed higher hazard ratios for women than in men (Table). Gender × LVH interaction terms were statistically significant in part of the LVH criteria. In adjusted Cox models, Sokolow–Lyon voltage performed the best (Table). The composite of Sokolow–Lyon voltage and Cornell voltage was statistically significantly associated with events in women (P = 0.001) and in men (P = 0.02).Conclusions: Gender affects both the prevalence rates and prognostic values of ECG LVH criteria in the general population, with showing higher prognostic value of ECG LVH in women than in men. For clinical use, the composite of Sokolow–Lyon voltage and Cornell voltage seem to be a good option.
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