Electrocardiographic Left Ventricular Hypertrophy and Risk of Coronary Heart Disease

Risk of clinically overt coronary heart disease in 190 persons with "definite" and 264 with "possible" electrocardiographic left ventricular hypertrophy (ECG-LVH) was compared with that of a total cohort of 5,127 men and women followed over 14 years. Prevalence of both coronary heart disease and ECG-LVH increased in proportion to antecedent blood pressure. Persons who acquired "definite" ECG-LVH had a residual threefold increased risk of clinically overt coronary heart disease after adjustment for the effect of coexisting hypertension. "Possible" ECG-LVH was associated with a twofold increased risk, but this was virtually obliterated on adjustment for hypertension. Risk of every clinical manifestation of coronary heart disease, and of death in particular, was increased, and 40% with prior ECG-LVH died in their initial attack, a fatality rate comparable with that of persons with prior overt coronary heart disease. ECG-LVH is thus a grave prognostic sign and a harbinger of clinically overt coronary heart disease. It is tempting to hypothesize that ECG-LVH without other explanation based mainly on increased voltage (possible LVH) is largely an expression of hypertensive hypertrophy and that with more marked voltage increases accompanied by S-T and T wave abnormality (definite LVH) indicates ischemic myocardial involvement.