Prevalence Of LVH Research Articles

933-100 Effect of 6 Antihypertensive Drugs on ECG Left Ventricular Hypertrophy

Both ECG and echo LVH are markers of increased risk, but there is much less information on interdrug differences in ECG LVH regression. Therefore, changes in ECG LVH prevalence were examined after 3 mos titration phase and a 1 yr maintenance phase of randomized double-blind treatment with atenolol (AT), captopril (CP), clonidine (CL), diltiazem (DT), hydrochlorothiazide (HZ), prazosin (PZ) or placebo (PL) in 570 men with mild-moderate hypertension. The prevalence of Sokolow-Lyon (SL) and Minnesota code (MC) criteria were evaluated, as well as precordial voltage (Svl+ Rv5). Percent changes from baseline were:Empty Cell% of patients with LVHPrecordial Voltage (mV*10)Empty CellSL+MCEmpty CellEmpty CellEmpty CellRXBase3 mos1 yrBase3 mos1 yrBase3 mas1 yrAT12+9*+917+7#+1527.1+0.6-0.1CP23-8*-433-7-428.10+0.2CL16+3022+5+228.4+0.3-0.4DT18+5+829+6+16@30.0-0.9-0.5HZ26-5-941-8#-9@29.4-0.5-1.5PZ23+1-433-1+328.4-0.1+0.7PL16+5-25+7-28.3+0.4+1.1*AT v CP 3 mos#HZ v AT 3 mos@HZ v DZ 1 yr (p < 0.05) AT v CP 3 mos HZ v AT 3 mos HZ v DZ 1 yr (p < 0.05) Thus, HZ caused a decrease in LVH prevalence, while AT and DT caused an increase. These changes are concordant with echo observations, where HZ was the only drug to significantly reduce LV mass for equal levels of systolic BP reduction.

Left Ventricular Hypertrophy in Hypertension — General and Local Trends in Diagnosis and Therapy

LVH is a frequent echocardiographic finding in the general population but it should be regarded as an ominous predictor of future cardiovascular events rather than an innocent compensatory phenomenon. Echocardiography is the most sensitive and specific method for its detection but the ECG should not be regarded as superfluous since additional prognostic information and information about coexisting myocardial damage is present. The decreasing prevalence of LVH suggests that LVH can be prevented by control of hypertension and prevention of weight gain. Once LVH is present then antihypertensive drugs, weight reduction or salt restriction may promote its reversal, with early studies demonstrating associated improvement in mortality and morbidity.

Electrocardiographic diagnosis of left ventricular hypertrophy in the presence of bundle branch block

Autopsy and echocardiographic studies indicate that ECG criteria for LVH tend to maintain their sensitivity in the presence of LBBB, with the exception of left precordial lead criteria alone. With RBBB, ECG criteria for LVH using right precordial S waves and combination criteria of right precordial S waves and left precordial R waves have a marked reduction in sensitivity, whereas left precordial R wave criteria have modestly reduced sensitivity. Limb lead criteria for LVH have increased sensitivity in the presence of RBBB and, to a lesser extent, in the presence of LBBB. Acceptable sensitivity for the diagnosis of LVH in patients with bundle branch block requires a combination of limb and precordial lead voltage criteria and/or other nonvoltage ECG criteria, since the prevalence of LVH in the presence of RBBB or LBBB appears higher than the sensitivity of individual criteria.

Left Ventricular Hypertrophy as a Risk Factor for Arrhythmias in Hemodialysis Patients

The contribution of left ventricular hypertrophy in determining ventricular arrhythmias (VAS) was studied in 81 chronic renal failure patients in chronic hemodialysis using two-dimensional echocardiographic and electrocardiogram Holter monitoring. The prevalence of LVH was 93% (96% in hypertensive and 87% in normotensive patients). The prevalence of VA was 48%. These arrhythmias were associated with increased cardiac mass, lack of potassium supplementation to the hemodialysis bath, and low K+ and PaO2 during dialysis. Severe forms of VA occurred in 19 of 78 patients, and the risk factors for this occurrence were (a) largely increased cardiac mass indices (exceeding in more than 40% the upper limit of normal for each sex) and (b) prolonged periods of time in hemodialysis treatment (34 +/- 5.5 vs. 17 +/- 2.7 months, p less than 0.05). Changes in potassium or oxygen content of the blood were not significantly associated with the occurrence of severe forms of VA.