Relation of echocardiographic left ventricular mass and hypertrophy to persistent electrocardiographic left ventricular hypertropy in hypertensive patients: The LIFE study

Background: The Losartan Intervention For Endpoint Reduction in Hypertensio n (LIFE) trial used left ventricular hypertrophy (LVH) on a screening ECG t o identify patients at high risk for morbid events. Because of regression t o the mean, not all patients who met screening criteria had persistent ECG LVH on the ECG performed at study baseline. Methods: The relationship of echocardiographic LV mass and LVH to persisten ce or loss of ECG LVH between screening and baseline evaluation was examine d in 906 hypertensive patients in the LIFE study, who had echocardiograms a nd additional ECG performed at study baseline. Patients were categorized ac cording to the presence or absence of ECG LVH by Cornell voltage-duration p roduct criteria or Sokolow-Lyon voltage criteria; echocardiographic LVH was defined by LV mass index (LVMI) > 104 g/m(2) in women and > 116 g/m(2) in men. Results: A total of 678 patients (75%) had persistent ECG LVH at baseline e valuation. Compared with the 228 patients without ECG LVH on the second ECG by either criterion, the 106 patients with LVH by both Cornell product and Sokolow-Lyon criteria had significantly higher LVMI (140 +/- 31 v 114 +/- 21 g/m(2), P < .001) and a higher prevalence of echocardiographic LVH (86% v 55%, P < .001). Patients with ECG LVH on the baseline ECG by either Corne ll product criteria (n = 410) or Sokolow-Lyon voltage criteria (n = 162) ha d intermediate values of LVMI (125 +/- 25 and 121 +/- 21 g/m(2)) and preval ences of echocardiographic LVH (78% and 62%). After controlling for possibl e effects of age, sex. ethnicity, systolic blood pressure, and body mass in dex, persistence of ECG LVH on the baseline ECG was associated with an incr eased risk of echocardiographic LVH: compared with patients with neither EC G criteria for LVH, patients with only Sokolow-Lyon voltage criteria had a 1.2-fold increased risk of echocardiographic LVH, those with only Cornell p roduct criteria had a 2.7-fold increased risk, and patients with both ECG c riteria had a 4.1-fold increased risk of echocardiographic LVH (P < .001). Conclusions: Persistent ECG LVH between screening and LIFE study baseline i dentified patients with greater LV mass and a higher prevalence of echocard iographic LVH. suggesting that these patients may be at higher risk for su sequent morbid and mortal events. (C) 2001 American Journal of Hypertension , Ltd.