Electrocardiographic left ventricular hypertrophy in GUSTO IV ACS: an important risk marker of mortality in women

Eur Heart J. 2007 Sep;28(17):2064-9. doi: 10.1093/eurheartj/ehm223. Epub 2007 Jun 28.

Abstract

Aim: To examine the association of left ventricular hypertrophy (LVH) on admission electrocardiography with adverse outcomes in acute coronary syndrome (ACS) patients.

Methods and results: A total of 7443 non-ST-elevation ACS patients in Global Utilization of STrategies to Open occluded arteries (GUSTO) IV ACS trial had admission electrocardiograms analysed at a core laboratory. LVH [>or=20 mm Cornell voltage (LV voltage) (women) or >or=28 mm (men) plus strain patterns] was observed in 586 (7.9%) patients, and women accounted for 74%. LVH patients were also older and had more co-morbidities, ST-depression >or= 0.5 mm, elevated C-reactive protein and N-terminal pro-brain naturetic peptide (NT-proBNP), and lower troponin T. Invasive procedures occurred less often in LVH patients (cardiac catheterization: 31 vs. 38%, P = 0.001; percutaneous coronary intervention: 12 vs. 20%, P < 0.001). Mortality was significantly higher in patients with LVH (30 day: 5 vs. 3%, P = 0.046; 1 year: 14 vs. 7%, P < 0.001), whereas 30 day myocardial infarction (MI) and death/MI did not differ. After baseline adjustment including NT-proBNP, LVH remained associated with increased hazard of 1 year mortality in women, but not in men [P-interaction = 0.033; women: adjusted hazard ratio (LVH vs. no LVH): 1.42 (1.04-1.94), P = 0.029].

Conclusion: Electrocardiographic-LVH identifies an important subset of ACS patients with a higher risk of long-term mortality, particularly among women. These novel findings highlight opportunities to improve treatment and outcome among similar ACS patients.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / diagnosis
  • Acute Coronary Syndrome / mortality*
  • Acute Coronary Syndrome / therapy
  • Adult
  • Aged
  • Biomarkers / blood
  • Cardiac Catheterization / statistics & numerical data
  • Death, Sudden, Cardiac / etiology
  • Electrocardiography / methods*
  • Female
  • Humans
  • Hypertrophy, Left Ventricular / diagnosis
  • Hypertrophy, Left Ventricular / mortality*
  • Hypertrophy, Left Ventricular / therapy
  • Male
  • Middle Aged
  • Myocardial Infarction / mortality*
  • Prognosis
  • Risk Factors
  • Sex Factors

Substances

  • Biomarkers