From the Guidelines
An ECG showing hypertrophy (HVG) is a significant finding that implies an increased risk of cardiovascular mortality and morbidity, and therefore, warrants further evaluation and management to reduce the risk of adverse outcomes. The implications of an ECG showing hypertrophy are significant, as it is associated with an increased risk of cardiovascular events, including stroke and all-cause mortality, as suggested by the 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults 1. According to this guideline, echocardiographic evidence of left ventricular hypertrophy (LVH) has additive discriminatory power over ECG evidence of LVH, and the presence of concentric rather than eccentric hypertrophy in the hypertensive population carries the highest risk. Key points to consider in the management of patients with ECG findings of hypertrophy include:
- The association between pathological hypertrophy and cardiovascular disease (CVD) has been studied in hypertensive populations, with a 40% higher risk of cardiovascular events for each 39 g/m2 greater left ventricular mass index, as seen in the MAVI study 1.
- Left ventricular architecture is an important variable related to risk, with concentric hypertrophy carrying the highest risk.
- The epidemiological association between LVH and CVD has also been studied in other populations, suggesting a significant link between the two 1. In clinical practice, the finding of hypertrophy on an ECG should be taken seriously, and patients should be evaluated for underlying conditions such as hypertension, and managed accordingly to reduce the risk of cardiovascular morbidity and mortality.
From the Research
Implications of Electrocardiogram (ECG) Showing Hypertrophy (HVG)
- An ECG showing hypertrophy (HVG) is a strong, blood-pressure independent risk factor for cardiovascular morbidity and mortality 2, 3, 4, 5, 6.
- The presence of left ventricular hypertrophy (LVH) is associated with an increased incidence of ventricular arrhythmias, myocardial infarction, congestive heart failure, stroke, and cardiovascular mortality 5.
- Echocardiography is more sensitive than electrocardiography in detecting left ventricular hypertrophy, and can identify patients with borderline hypertension who need treatment 5.
- Regression of LVH can be achieved through weight reduction and drug therapy, including beta-adrenergic blockers, angiotensin converting enzyme inhibitors, calcium channel blockers, and sympatholytic agents 4, 5, 6.
- Certain antihypertensive drugs, such as ACE inhibitors and calcium channel blockers, are more effective in reducing LVH than others, such as beta-blockers and diuretics 2, 3.
- Reduction of LVH seems to be determined by pretreatment LVM, decline in BP, and duration of drug treatment 3.
- Decreased LV mass in hypertensive patients may be associated with an improvement in diastolic function and has not been found to produce adverse effects on LV systolic performance 4.