European Heart Journal Advance Access originally published online on June 28, 2007
European Heart Journal 2007 28(17):2064-2069; doi:10.1093/eurheartj/ehm223
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Electrocardiographic left ventricular hypertrophy in GUSTO IV ACS: an important risk marker of mortality in women
1 Canadian VIGOUR Centre Research Group, 214 Heritage Medical Research Centre, University of Alberta, Edmonton, Alberta, Canada T6G 2S2
2 Cleveland Clinic Foundation, Cleveland, OH, USA
3 Department of Medical Sciences, University of Uppsala, Uppsala, Sweden
4 Department of Cardiology, University of Uppsala, Uppsala, Sweden
Received 3 December 2006; revised 20 April 2007; accepted 10 May 2007; online publish-ahead-of-print 28 June 2007.
* Corresponding author. Tel: +1 780 492 9385; fax: +1 780 492 0613. E-mail address: cindy.westerhout{at}ualberta.ca
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 [
20 mm Cornell voltage (LV voltage) (women) 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 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.
Key Words: Left ventricular hypertrophy • Mortality • Gender