Echocardiographic left ventricular geometry in hypertensive patients with electrocardiographic left ventricular hypertrophy: The LIFE study

Aim: To assess the prevalence of echocardiographic left ventricular hypertr ophy (LVH) and concentric remodeling in hypertensive patients with electroc ardiographic (ECC;)-LVH and to estimate the cost-effectiveness of echocardi ography and ECG for detection of LVH. Design: Echocardiographic LV measurem ents and the prevalence of abnormal LV geometric patterns were compared bet ween 964 hypertensive patients with ECC-LVH (Cornell voltage-duration produ ct >2440 and/or SV1 +/- RV5-6 > 38 mm) participating in the LIFE trial and groups of 282 employed hypertensives and 366 apparently normal adults. Resu lts: Among both women and men, stepwise increases from reference subjects t o employed hypertensives to LIFE patients were observed for LV wall thickne sses, chamber size and mass. Mean LV mass/body surface area (BSA) and LV ma ss/height(2.7) were substantially larger in LIFE patients than normal adult s among women(113 vs 69 g/m(2) and 55 vs 32 g/m(2.7), p < 0.001) and men (1 27 vs 83 g/ m(2) and 55 vs 36 g/m(2.7), p < 0.001), with intermediate value s in employed hypertensives. Compared to the latter group, LIFE patients ha d higher prevalences of concentric LVH (25-29% vs 3-4%) and eccentric LVH ( 45-51% vs 13-17%) but not concentric LV remodeling (8-11% vs 12-14%). LVH w as present in 70% of LIFE patients by LV mass/BSA criteria and 76% by LV ma ss/height(2.7) criteria (odds ratios = 11.4 and 13.5 vs employed hypertensi ves). Conclusions: The ECG criteria used in LIFE identify hypertensive pati ents with a >70% prevalence of anatomic LVH, allowing accurate identificati on of high-risk status by this commonly used technique.