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

Aim: To assess the prevalence of echocardiographic left ventricular hypertrophy (LVH) and concentric remodeling in hypertensive patients with electrocardiographic (ECG)-LVH and to estimate the cost-effectiveness of echocardiography and ECG for detection of LVH. Design: Echocardiographic LV measurements and the prevalence of abnormal LV geometric patterns were compared between 964 hypertensive patients with ECG-LVH (Cornell voltage-duration product >2440 and/or SV₁ ± RV_5-6 > 38 mm) participating in the LIFE trial and groups of 282 employed hypertensives and 366 apparently normal adults. Results: Among both women and men, stepwise increases from reference subjects to employed hypertensives to LIFE patients were observed for LV wall thicknesses, chamber size and mass. Mean LV mass/body surface area (BSA) and LV mass/height^2.7 were substantially larger in LIFE patients than normal adults among women (113 vs 69 g/m² and 55 vs 32 g/m^2.7, p < 0.001) and men (127 vs 83 g/m² and 55 vs 36 g/m^2.7, p < 0.001), with intermediate values in employed hypertensives. Compared to the latter group, LIFE patients had 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 was present in 70% of LIFE patients by LV mass/BSA criteria and 76% by LV mass/height^2.7 criteria (odds ratios = 11.4 and 13.5 vs employed hypertensives). Conclusions: The ECG criteria used in LIFE identify hypertensive patients with a > 70% prevalence of anatomic LVH, allowing accurate identification of high-risk status by this commonly used technique.