The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

Regression of Electrocardiographic Left Ventricular Hypertrophy Is Associated with Less Hospitalization for Heart Failure in Hypertensive Patients

Peter M. Okin, MD; Richard B. Devereux, MD; Katherine E. Harris, DrPH; Sverker Jern, MD; Sverre E. Kjeldsen, MD, PhD; Stevo Julius, MD, ScD; Jonathan M. Edelman, MD; Björn Dahlöf, MD, PhD, LIFE Study Investigators
[+] Article, Author, and Disclosure Information

From Weill Medical College of Cornell University, New York, New York; Amgen, San Francisco, California; Sahlgrenska University Hospital/Östra, Göteborg, Sweden; Ullevål University Hospital, Oslo, Norway; University of Michigan Medical Center, Ann Arbor, Michigan; and Merck & Co., Whitehouse Station, New Jersey.

Grant Support: In part by grant COZ-368 and an Investigator Initiated Study grant from Merck & Co., Inc., West Point, Pennsylvania.

Potential Financial Conflicts of Interest: Employment: K.E. Harris (Merck & Co. Inc.), J.M. Edelman (Merck & Co. Inc.). Consultancies: R.B. Devereux (Merck & Co. Inc.), S. Julius (Merck & Co. Inc.), B. Dahlöf (Merck & Co. Inc., Novartis, Boehringer Ingelheim, Pfizer Inc.). Honoraria: R.B. Devereux (Merck & Co. Inc.), S.E. Kjeldsen (AstraZeneca, Bayer, Merck & Co. Inc., Novartis, Pfizer Inc., Boehringer Ingelheim, Sankyo, Bristol-Myers Squibb), S. Julius (Merck & Co. Inc.), B. Dahlöf (Servier, Merck & Co. Inc., Novartis, Boehringer Ingelheim, Pfizer Inc.). Stock ownership or options (other than mutual funds): J.M. Edelman (Merck & Co. Inc.); Grants received: P.M. Okin (Merck & Co. Inc.), R.B. Devereux (Merck & Co. Inc.).

Requests for Single Reprints: Peter M. Okin, MD, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021; e-mail, pokin@med.cornell.edu.

Current Author Addresses: Drs. Okin and Devereux: Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021.

Dr. Harris: Amgen, Inc., 1120 Veterans Boulevard, San Francisco, CA 94080.

Drs. Jern and Dahlöf: Sahlgrenska University Hospital/Östra, SE-416 85, Göteborg, Sweden.

Dr. Kjeldsen: Ullevål University Hospital, Kirkeveien 166, Oslo, Norway.

Dr. Julius: University of Michigan Medical Center, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106.

Dr. Edelman: Merck & Co., Inc., 351 North Sumneytown Pike, PO Box 1000, Mail Stop UG4C-94, North Wales, PA 19454.

Author Contributions: Conception and design: P.M. Okin, R.B. Devereux, K.E. Harris, S.E. Kjeldsen, S. Julius, J.M. Edelman, B. Dahlöf.

Analysis and interpretation of the data: P.M. Okin, K.E. Harris, S.E. Kjeldsen, S. Julius, J.M. Edelman, B. Dahlöf.

Drafting of the article: P.M. Okin.

Critical revision of the article for important intellectual content: P.M. Okin, R.B. Devereux, S. Jern, S.E. Kjeldsen, S. Julius, B. Dahlöf.

Final approval of the article: P.M. Okin, R.B. Devereux, S. Jern, S.E. Kjeldsen, S. Julius.

Provision of study materials or patients: J.M. Edelman.

Statistical expertise: P.M. Okin, S.E. Kjeldsen.

Obtaining of funding: P.M. Okin, R.B. Devereux, S.E. Kjeldsen, J.M. Edelman, B. Dahlöf.

Administrative, technical, or logistic support: J.M. Edelman.

Collection and assembly of data: K.E. Harris, S. Jern, S.E. Kjeldsen, J.M. Edelman.

Ann Intern Med. 2007;147(5):311-319. doi:10.7326/0003-4819-147-5-200709040-00006
Text Size: A A A

Background: Reduction of electrocardiographic left ventricular hypertrophy (LVH) has been associated with decreased cardiovascular death, stroke, myocardial infarction, and atrial fibrillation. However, whether reduction of electrocardiographic LVH is associated with decreased heart failure is unclear.

Objective: To examine the relation of reduction of electrocardiographic LVH to incident heart failure.

Design: Multicenter cohort study derived from a randomized, controlled trial.

Setting: Losartan Intervention For Endpoint reduction in hypertension study.

Patients: 8479 hypertensive patients without history of heart failure who were randomly assigned to losartan or atenolol treatment.

Measurements: Change in Cornell product electrocardiographic LVH between baseline and in-study electrocardiograms, examined as both a continuous variable and a dichotomous variable (above or below the median decrease of 236 mm · msec) to predict heart failure hospitalization occurring after the 6-month follow-up visit.

Results: During mean follow-up of 4.7 years (SD, 1.1 years), 214 patients were hospitalized for heart failure (2.5%): 77 patients with an in-treatment decrease of 236 mm · msec or more (4.4 per 1000 patient-years) and 137 patients with a reduction less than 236 mm · msec during treatment (6.8 per 1000 patient-years). In a univariate Cox analysis in which change in Cornell product was treated as a time-varying continuous variable, decrease in Cornell product during treatment was associated with a decreased risk for new-onset heart failure, with a 24% lower risk for heart failure for every 817–mm · msec (1 SD of the mean) lower Cornell product (hazard ratio, 0.76 [95% CI, 0.72 to 0.80]). In a parallel analysis in which change in Cornell product was entered as a time-varying dichotomous variable, a greater-than-median in-treatment decrease in Cornell product (236 mm · msec) was associated with a 43% lower risk for heart failure (hazard ratio, 0.57 [CI, 0.44 to 0.76]). After adjustment for treatment, baseline risk factors for heart failure, baseline and in-treatment blood pressure, and baseline severity of electrocardiographic LVH, in-treatment decrease of Cornell product LVH in time-varying multivariate Cox models remained strongly associated with new heart failure hospitalization, with a 19% lower risk for every 817–mm · msec lower Cornell product treated as a continuous variable (hazard ratio, 0.81 [CI, 0.77 to 0.85]) or a 36% decreased rate of new heart failure in patients with an in-treatment reduction in Cornell product of 236 mm · msec or more (hazard ratio, 0.64 [CI, 0.47 to 0.89]; P < 0.001 for all comparisons).

Limitations: Use of electrocardiographic LVH to select patients may have increased risk compared with unselected hypertensive patients, and use of hospitalization for heart failure as the end point will underestimate the incidence of new heart failure.

Conclusion: Reduction in Cornell product electrocardiographic LVH during antihypertensive therapy is associated with fewer hospitalizations for heart failure, independent of blood pressure lowering, treatment method, and other risk factors for heart failure.

ClinicalTrials.gov registration number: NCT00338260.


Grahic Jump Location
Figure. Patient group assignment was adjusted at the time of each electrocardiogram on the basis of the Cornell product at that time .
Rate of new-onset heart failure according to presence or absence of a 236–mm · msec reduction in Cornell product left ventricular hypertrophy (LVH).(33)
Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.