Prognostic Usefulness of Left Ventricular Hypertrophy by Electrocardiography in Patients With Atrial Fibrillation (from the Randomized Evaluation of Long-Term Anticoagulant Therapy Study) - 31/01/14
, Gianpaolo Reboldi, MD, PhD b, Giuseppe Di Pasquale, MD c, Giovanni Mazzotta, MD d, Giuseppe Ambrosio, MD d, Sean Yang, PhD e, Janice Pogue, PhD e, Lars Wallentin, MD f, Michael D. Ezekowitz, MD g, h, Stuart J. Connolly, MD e, Salim Yusuf, MD eOn behalf of the
RE-LY Study Investigators
Abstract |
It is unknown whether left ventricular hypertrophy (LVH) diagnosis by electrocardiography improves risk stratification in patients with atrial fibrillation (AF). We investigated the prognostic impact of LVH diagnosis by electrocardiography in a large sample of anticoagulated patients with AF included in the Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) Study. We defined electrographic LVH (ECG-LVH) by strain pattern or Cornell voltage (R wave in aVL plus S wave in V3) >2.0 mV (women) or >2.4 mV (men). LVH prevalence was 22.7%. During a median follow-up of 2.0 years, 303 patients developed a stroke, 778 died (497 from cardiovascular causes), and 140 developed a myocardial infarction. LVH was associated with a greater risk of stroke (1.99% vs 1.32% per year, hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.18 to 1.93, p <0.001), cardiovascular death (4.52% vs 1.80% per year, HR 2.56, 95% CI 2.14 to 3.06, p <0.0001), all-cause death (6.03% vs 3.11% per year, HR 1.95, 95% CI 1.68 to 2.26, p <0.0001), and myocardial infarction (1.11% vs 0.55% per year, HR 2.07, 95% CI 1.47 to 2.92, p <0.0001). In multivariate analysis, the prognostic value of LVH was additive to CHA2DS2-VASc score and other covariates. The category-free net reclassification index and integrated discrimination improvement increased significantly after adding LVH to multivariate models. In conclusion, our study demonstrates for the first time that ECG-LVH, a simple and easily accessible prognostic indicator, improves risk stratification in anticoagulated patients with AF.
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| This study is registered at www.clinicaltrials.gov (NCT00262600). |
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| This study was funded by Boehringer-Ingelheim, Ingelheim am Rein, Germany and the Fondazione Umbra Cuore e Ipertensione–ONLUS, Perugia, Italy. |
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| See page 674 for disclosure information. |
Vol 113 - N° 4
P. 669-675 - février 2014 Retour au numéro
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