Left ventricular hypertrophy is a predictor of cardiovascular events in elderly hypertensive patients
Riitta AntikaínenRuth PetersNigel BeckettRobert FagardJi‐Guang WangChakravarthi RajkumarChristopher J. Bulpitt
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We assessed the prognostic value of ECG left ventricular hypertrophy (LVH) using Sokolow-Lyon (SL-LVH), Cornell voltage (CV-LVH) or Cornell product (CP-LVH) criteria in 3043 hypertensive people aged 80 years and over enrolled in the Hypertension in the Very Elderly Trial.Multivariate Cox proportional hazard models were used to estimate hazard ratios with 95% confidence intervals (CIs) for all-cause mortality, cardiovascular diseases, stroke and heart failure in participants with and without LVH at baseline. The mean follow-up was 2.1 years.LVH identified by CV-LVH or CP-LVH criteria was associated with a 1.6-1.9-fold risk of cardiovascular disease and stroke. The presence of CP-LVH was associated with an increased risk of heart failure (hazard ratio 2.38, 95% CI 1.16-4.86). In sex-specific analyses, CV-LVH (hazard ratio 1.94, 95% CI 1.06-3.55) and CP-LVH (hazard ratio 2.36, 95% CI 1.25-4.45) were associated with an increased risk of stroke in women and of heart failure in men, CV-LVH (hazard ratio 6.47, 95% CI 1.41-29.79) and CP-LVH (10.63, 95% CI 3.58-31.57), respectively. There was no significant increase in the risk of any outcomes associated with Sokolow-Lyon-LVH. LVH identified by these three methods was not a significant predictor of all-cause mortality.Use of Cornell voltage and Cornell product criteria for LVH predicted the risk of cardiovascular disease and stroke. Only Cornell product was associated with an increased risk of heart failure. This was particularly the case in men. The identification of ECG LVH proved to be important in very elderly hypertensive people.Keywords:
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Letters and Corrections1 November 1989Medical Therapy for Chronic Congestive Heart FailureKenneth M. Kessler, MDKenneth M. Kessler, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-111-9-768 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editor:The editorial by Drs. Jaeschke and Guyatt (1) on the medical therapy for chronic congestive heart failure was concise, timely, and well focused; however, the treatment subgroup was assumed and not defined. Currently, there are four studies (2-4) demonstrating that approximately 30% of patients with congestive heart failure have normal left ventricular ejection fractions. Such patients cannot be clinically discerned from those with abnormal ejection fractions, rarely have marked hypertrophy or hypertrophic cardiomyopathy, but frequently have hypertensive or ischemic heart disease with accompanying diastolic left ventricular dysfunction. Pertinent to medical therapy, patients with normal ejection fractions do...References1. JaeschkeGuyatt RG. Medical therapy in chronic congestive heart failure [Editorial]. Ann Intern Med. 1989;110:758-60. LinkGoogle Scholar2. EcheverriaBilskerMyerburgKessler HMRK. Congestive heart failure: echocardiographic insights. Am J Med. 1983;75:750-5. CrossrefMedlineGoogle Scholar3. SouferWohlgelernterVita RDN. Intact systolic left ventricular function in clinical congestive heart failure. Am J Cardiol. 1985;55:1032-6. CrossrefMedlineGoogle Scholar4. AguirrePearsonLewen FAM. Usefulness of doppler echocardiography in the diagnosis of congestive heart failure. Am J Cardiol. 1989;63:1098-102. CrossrefMedlineGoogle Scholar5. Kessler K. Heart failure with normal systolic function. Arch Intern Med. 1988;148:2109-11. CrossrefMedlineGoogle Scholar1. JaeschkeGuyatt RG. Medical therapy for congestive heart failure. [Editorial]. Ann Intern Med. 1989;110:758-60. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: University of Miami Veterans Administration Medical Center Miami, FL 33125 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byCongestive heart failure in coronary artery diseaseCardiac failure in coronary heart disease 1 November 1989Volume 111, Issue 9Page: 768-769KeywordsCardiomyopathiesCardiovascular therapyEjection fractionHeart failureLeft ventricular ejection fractionLongitudinal studies Issue Published: 1 November 1989 PDF downloadLoading ...
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Case Reports1 November 1949GREAT REDUCTION IN HEART SIZE ATTENDING THE CLEARING OF CONGESTIVE HEART FAILURE IN A MAN WITH HYPERTENSIVE AND CORONARY HEART DISEASEJAMES H. CURRENS, M.D., PAUL D. WHITE, M.D., F.A.C.P.JAMES H. CURRENS, M.D.Search for more papers by this author, PAUL D. WHITE, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-31-5-912 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe treatment of many patients with cardiac dropsy has been discouraging in the past in spite of the use of digitalis and mercurial diuretics which oftentimes give striking temporary improvement. In the majority of patients with congestive failure resulting from hypertensive and coronary heart disease, however, experience has shown that edema and dyspnea return with monotonous regularity even though activities are kept at a minimum. In the past few years the importance of a low sodium dietary intake has become increasingly apparent as a means of preventing the re-appearance of all the signs of congestive heart failure, particularly among the...Bibliography1. SCHROEDER HA: Studies in congestive heart failure, Am. Heart Jr., 1941, xxii, 141. CrossrefGoogle Scholar2. PROGERGINSBURGMAGENDANTZ SEH: Effects of ingestion of excessive amounts of sodium chloride and water on patients with heart disease, Am. Heart Jr., 1942, xxiii, 555. CrossrefGoogle Scholar3. ELLIS LB: Relative importance of salt and fluid in the management of congestive heart failure, Trans. New Eng. Heart Assoc., 1942, 33-34. Google Scholar4. SCHEMM FR: High fluid intake in management of edema, especially cardiac edema. I. Details and bases of regime, Ann. Int. Med., 1942, xvii, 952; High fluid intake in management of edema, especially cardiac edema. II. Clinical observations and data, Ann. Int. Med., 1944, xxi, 937. LinkGoogle Scholar5. WHEELERBRIDGESWHITE EOWCPD: Diet low in salt (sodium) in congestive heart failure, Jr. Am. Med. Assoc., 1947, xvi, 133. Google Scholar6. KEMPNER W: Treatment of cardiac failure with the rice diet, North Carolina Med. Jr., 1947, viii, 128. Google Scholar7. KARRELL P: De le cure de lait, Arch. gén. de méd., 1866, ii, 513. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Boston, Massachusetts*Received for publication August 28, 1947. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 November 1949Volume 31, Issue 5Page: 912-917KeywordsCoronary heart diseaseDiureticsDyspneaEdemaHeart failurePatientsSodium ePublished: 1 December 2008 Issue Published: 1 November 1949 PDF downloadLoading ...
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We assessed the prognostic value of ECG left ventricular hypertrophy (LVH) using Sokolow-Lyon (SL-LVH), Cornell voltage (CV-LVH) or Cornell product (CP-LVH) criteria in 3043 hypertensive people aged 80 years and over enrolled in the Hypertension in the Very Elderly Trial.Multivariate Cox proportional hazard models were used to estimate hazard ratios with 95% confidence intervals (CIs) for all-cause mortality, cardiovascular diseases, stroke and heart failure in participants with and without LVH at baseline. The mean follow-up was 2.1 years.LVH identified by CV-LVH or CP-LVH criteria was associated with a 1.6-1.9-fold risk of cardiovascular disease and stroke. The presence of CP-LVH was associated with an increased risk of heart failure (hazard ratio 2.38, 95% CI 1.16-4.86). In sex-specific analyses, CV-LVH (hazard ratio 1.94, 95% CI 1.06-3.55) and CP-LVH (hazard ratio 2.36, 95% CI 1.25-4.45) were associated with an increased risk of stroke in women and of heart failure in men, CV-LVH (hazard ratio 6.47, 95% CI 1.41-29.79) and CP-LVH (10.63, 95% CI 3.58-31.57), respectively. There was no significant increase in the risk of any outcomes associated with Sokolow-Lyon-LVH. LVH identified by these three methods was not a significant predictor of all-cause mortality.Use of Cornell voltage and Cornell product criteria for LVH predicted the risk of cardiovascular disease and stroke. Only Cornell product was associated with an increased risk of heart failure. This was particularly the case in men. The identification of ECG LVH proved to be important in very elderly hypertensive people.
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In autonomic failure (AF), supine hypertension may predispose patients to end-organ damage. The pathophysiology of hypertensive heart disease in AF is not known. The aim of the present study was to evaluate the prevalence and predisposing factors of left ventricular hypertrophy (LVH) in patients with AF. We studied 25 patients with AF (67 ± 8 years); 80% were being treated for orthostatic hypotension. Twenty patients with essential hypertension (68 ± 6 years) were considered as the control group. All subjects underwent echocardiography for measurement of left ventricular mass (LVM). The patients with AF underwent a 24-h BP monitoring and long-term blood pressure (BP) variability was calculated as standard deviation (SD) of the average of the half-hour mean values. The LVM is comparable in patients with AF and hypertensive controls (145 ± 35 g/m2v 127 ± 32 g/m2, P = .07). The proportion of patients with LVH is similar in both populations (AF 80%, hypertensive 70%). The patients with AF were divided into two groups, with and without LVH. The SDs are significantly higher in AF patients with LVH than in those with normal LVM (SD 24-h systolic BP: 22 ± 4 v 14 ± 1 mm Hg, P = .001). A high proportion of patients with AF show LVH. The LVM values are comparable with those of patients with essential hypertension. The development of LVH seems to depend on high BP variability, characteristic of AF patients. Detection of LVH may help in the choice of treatment for orthostatic hypotension and in the prevention of heart failure.
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Background Although most people with relapsing onset multiple sclerosis (R-MS) eventually transition to secondary progressive multiple sclerosis (SPMS), little is known about disability progression in SPMS. Methods All R-MS patients in the Cardiff MS registry were included. Cox proportional hazards regression was used to examine a) hazard of converting to SPMS and b) hazard of attaining EDSS 6.0 and 8.0 in SPMS. Results 1611 R-MS patients were included. Older age at MS onset (hazard ratio [HR] 1.02, 95%CI 1.01–1.03), male sex (HR 1.71, 95%CI 1.41–2.08), and residual disability after onset (HR 1.38, 95%CI 1.11–1.71) were asso- ciated with increased hazard of SPMS. Male sex (EDSS 6.0 HR 1.41 [1.04–1.90], EDSS 8.0 HR 1.75 [1.14–2.69]) and higher EDSS at SPMS onset (EDSS 6.0 HR 1.31 [1.17–1.46]; EDSS 8.0 HR 1.38 [1.19–1.61]) were associated with increased hazard of reaching disability milestones, while older age at SPMS was associated with a lower hazard of progression (EDSS 6.0 HR 0.94 [0.92–0.96]; EDSS 8.0: HR 0.92 [0.90–0.95]). Conclusions Different factors are associated with hazard of SPMS compared to hazard of disability progres- sion after SPMS onset. These data may be used to plan services, and provide a baseline for comparison for future interventional studies and has relevance for new treatments for SPMS RobertsonNP@cardiff.ac.uk
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Hypertensive heart disease (HHD) is a common problem in clinical practice. Left ventricular hypertrophy (LVH) is pathognomonic of HHD. Echo-Doppler study is the modality of choice to document cardiac involvement in hypertension. 'Radiology of chest and electrocardiography (ECG) are highly insensitive. Magnetic resonance imaging (MRI) produces similar results like echo but is not cost-effective. LVH is not merely related to haemodynamic load but several other factors are also involved in its genesis. LVH is a powerful and independent prognostic determinant for future cardiovascular and coronary events. LVH can be regressed by drugs but the aim in future should be prevention of LVH rather than its regression.
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ABSTRACT: Left ventricular ejection fraction was measured by gated wall motion in 62 patients, 75 years old or older, admitted to a Geriatric Acute Assessment Ward. From this group, 42 patients not taking digitalis or other cardioactive medication were selected for analysis. Thirty of them had clinically identifiable heart disease, whereas 12 did not. Resting left ventricular ejection fractions in the 12 patients without clinically identifiable heart disease averaged 0.60 ± 0.09. None had an ejection fraction below 0.50. In the 30 patients with clinically identifiable heart disease, mean ejection fraction was 0.49 ± 0.15 (range 0.17‐0.84), P < 0.01. In the patients with heart disease, reduction of ejection fraction was correlated with either cardiac enlargement or congestive heart failure. Neither age nor electrocardiographic abnormalities added to the strength of this correlation. Fifty‐eight per cent of patients with congestive heart failure had ejection fractions 3=0.40, suggesting that congestive heart failure in this age group is frequently related to diastolic left ventricular dysfunction unaccompanied by major systolic dysfunction. The prognosis of patients with congestive heart failure and ejection fractions above 0.35 was significantly better than of patients with congestive heart failure and ejection fractions below 0.35. From these data and other data available in the literature, it is proposed that the lower limit for ejection fraction be 0.50 for patients 75 years old or older. Congestive heart failure in patients 75 years old or older appears to be associated with relatively higher ejection fractions or even with ejection fractions within the normal range. In these patients, digitalis may not be indicated, and short term‐prognosis is relatively favorable.
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Left ventricular hypertrophy (LVH) is supposed to be a useful marker of cardiovascular complications during the course of hypertension. Authors compared the presence of heart failure, left ventricular diastolic dysfunction and chronic atrial fibrillation in hypertensive patients with and without left ventricular hypertrophy defined by echocardiography. Hospital records of 192 hypertensives treated in our medical department during years 1996-1999 were analysed. Left ventricular hypertrophy was defined by echocardiography (Penn convention) as left ventricular mass index > 134 g/m2 in men and > 110 g/m2 in women. Presence of LVH was found in 128 patients (mean age 65.9 years), absence of LVH in 64 patients (mean age 64.8 years). Both groups of hypertensives were matched by demographic parameters, by the presence of hyperlipidemia, by smoking habits. Hypertensive patients with left ventricular hypertrophy were more often treated by ACE inhibitors. There were statistically significant more patients with heart failure, left ventricular diastolic dysfunction and chronic atrial fibrillation in LVH-positive patients than in LVH-negative once. There was also statistically significant lower ejection fraction (50.3 +/- 11.4% vs 56.5 +/- 7.4%) in LVH-positive patients than in LVH-negative once. Left ventricular hypertrophy in patients with hypertension brings usually a complicated course of the disease with a high contribution to the development of chronic heart failure.
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The hazard ratio and median survival time are the routine indicators in survival analysis. We briefly introduced the relationship between hazard ratio and median survival time and the role of proportional hazard assumption. We compared 110 pairs of hazard ratio and median survival time ratio in 58 articles and demonstrated the reasons for the difference by examples. The results showed that the hazard ratio estimated by the Cox regression model is unreasonable and not equivalent to median survival time ratio when the proportional hazard assumption is not met. Therefore, before performing the Cox regression model, the proportional hazard assumption should be tested first. If proportional hazard assumption is met, Cox regression model can be used; if proportional hazard assumption is not met, restricted mean survival times is suggested.风险比（hazard ratio，HR）和中位生存时间是生存分析时的常规分析和报告指标。本文简要介绍了HR和中位生存时间的关系以及比例风险假定在这两者之间的作用，分析了检索出的58篇文献中的110对风险比和中位生存时间比的差异，并通过实例阐明了产生这种差异的原因。结果表明，在不满足比例风险假定时，Cox回归模型计算得到的风险比是不合理的，且与中位生存时间之比不等价。因此，在使用Cox回归模型前，应先进行比例风险假定的检验，只有符合比例风险假定时才能使用该模型；当不符合比例风险假定时，建议使用限制性平均生存时间。.
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