PROGNOSTIC VALUE OF A NEW ELECTROCARDIOGRAPHIC METHOD FOR DIAGNOSIS OF LEFT-VENTRICULAR HYPERTROPHY IN ESSENTIAL-HYPERTENSION

Objectives. We tested the prognostic value of a new electrocardiograph ic (EGG) method (Perugia score) for diagnosis of left ventricular hype rtrophy (LVH) in essential hypertension and compared it with five stan dard methods (Cornell voltage, Framingham criterion, Romhilt-Estes poi nt score, left ventricular strain, Sokolow-Lyon voltage). Background. Several standard ECG methods for assessment of LVH are used in the cli nical setting, but a comparative prognostic assessment is lacking. Met hods. A total of 1,717 white hypertensive subjects (mean age 52 years; 51% men) were prospectively followed up for up to 10 years (mean 3.3) . Results. At entry, the prevalence of LVH was 17.8% (Perugia score), 9.1% (Cornell), 3.9% (Framingham), 5.2% (Romhilt-Estes), 6.4% (strain) and 13.1% (Sokolow-Lyon). During follow-up there were 159 major cardi ovascular morbid events (33 fatal). The event rate was higher in the s ubjects with than in those without LVH (all p < 0.001) according to al l methods except the Sokoloa-Lyon method. By multivariate analysis, an independent association between LVH and cardiovascular disease risk w as maintained by the Perugia score (hazard ratio [HR] 2.04, 95% confid ence interval [CI] 1.5 to 2.8) and the Framingham (HR 1.91, 95% CI 1.1 to 3.2), Romhilt-Estes (HR 2.63, 95% CI 1.7 to 4.1) and strain method s (HR 2.11, 95% CI 1.4 to 3.2). The Perugia score showed the highest p opulation-attributable risk for cardiovascular events, accounting for 15.6% of all cases, whereas the Framingham, Romhilt-Estes and strain m ethods accounted for 3.0%, 7.4% and 6.8% of all events, respectively. LVH diagnosed by the Perugia score was also associated with an increas ed risk of cardiovascular mortality (HR 4.21, 95% CI 2.1 to 8.7), with a population-attributable risk of 37.0%. Conclusions. The Perugia sco re carried the highest population-attributable risk for cardiovascular morbidity and mortality compared with classic methods for detection o f LVH. Traditional interpretation of standard electrocardiography main tains an important role for cardiovascular risk stratification in esse ntial hypertension. (C) 1998 by the American College of Cardiology.