HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Okin, P. M. Search for Related Content PubMed PubMed Citation Articles by Okin, P. M.

CLINICAL STUDY

Relationship of the electrocardiographic strain pattern to left ventricular structure and function in hypertensive patients: the LIFE study

Peter M. Okin, MD, FACC^*, Richard B. Devereux, MD, FACC^*, Markku S. Nieminen, MD, PhD, FACC, Sverker Jern, MD, Lasse Oikarinen, MD, PhD, Matti Viitasalo, MD, PhD, Lauri Toivonen, MD, PhD, Sverre E. Kjeldsen, MD, PhD, Stevo Julius, MD, ScD, FACC^||, Björn Dahlöf, MD, PhD for the LIFE Study Investigators

^* Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, New York, USA
Division of Cardiology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
Sahlgrenska University Hospital/Östra, Göteborg, Sweden
Ullevål University Hospital, Oslo, Norway
^|| University of Michigan Medical Center, Ann Arbor, Michigan, USA

Manuscript received November 10, 2000; revised manuscript received March 1, 2001, accepted April 10, 2001.

Reprint requests and correspondence: Dr. Peter M. Okin, Cornell University Medical Center, 525 East 68th Street, New York, New York 10021
pokin{at}mail.med.cornell.edu

OBJECTIVES

This study was designed to assess the relation of electrocardiographic (ECG) strain to increased left ventricular (LV) mass, independent of its relation to coronary heart disease (CHD).

BACKGROUND

The classic ECG strain pattern, ST depression and T-wave inversion, is a marker for left ventricular hypertrophy (LVH) and adverse prognosis. However, the independence of the relation of strain to increased LV mass from its relation to CHD has not been extensively examined.

METHODS

Electrocardiograms and echocardiograms were examined at study baseline in 886 hypertensive patients with ECG LVH by Cornell voltage-duration product and/or Sokolow-Lyon voltage enrolled in the Losartan Intervention For End point (LIFE) echocardiographic substudy. Strain was defined as a downsloping convex ST segment with inverted asymmetrical T-wave opposite to the QRS axis in leads V₅ and/or V₆.

RESULTS

Strain occurred in 15% of patients, more commonly in patients with than without evident CHD (29%, 51/175 vs. 11%, 81/711, p < 0.001). When differences in gender, race, diabetes, systolic pressure, serum creatinine and high density lipoprotein cholesterol were controlled, strain on baseline ECG was associated with greater indexed LV mass in patients with (152 ± 33 vs. 131 ± 32 g/m², p < 0.001) or without CHD (131 ± 24 vs. 119 ± 22 g/m², p < 0.001). In logistic regression analyses, strain was associated with an increased risk of anatomic LVH in patients with CHD (relative risk 5.14, 95% confidence interval [CI] 1.16 to 22.85, p = 0.0315), without evident CHD (relative risk 2.91, 95% CI 1.50 to 5.65, p = 0.0016), and in the overall population when CHD was taken into account (relative risk 2.98, 95% CI 1.65 to 5.38, p = 0.0003).

CONCLUSIONS

When clinical evidence of CHD is accounted for, ECG strain is likely to indicate the presence of anatomic LVH. Greater LV mass and higher prevalence of LVH in patients with strain offer insights into the known association of the strain pattern with adverse outcomes.

Abbreviations and Acronyms   ASE = American Society of Echocardiography   CHD = coronary heart disease   ECG = electrocardiogram, electrocardiographic   ESS = end-systolic stress   HDL = high density lipoprotein   LIFE = Losartan Intervention For End point study   LV = left ventricular   LVH = left ventricular hypertrophy

This article has been cited by other articles:

				P. M. Okin, R. B. Devereux, K. E. Harris, S. Jern, S. E. Kjeldsen, S. Julius, J. M. Edelman, B. Dahlof, and for the LIFE Study Investigators Regression of Electrocardiographic Left Ventricular Hypertrophy Is Associated with Less Hospitalization for Heart Failure in Hypertensive Patients Ann Intern Med, September 4, 2007; 147(5): 311 - 319. [Abstract] [Full Text] [PDF]

				G. Salles, C. Cardoso, A. R. Nogueira, K. Bloch, and E. Muxfeldt Importance of the Electrocardiographic Strain Pattern in Patients With Resistant Hypertension Hypertension, September 1, 2006; 48(3): 437 - 442. [Abstract] [Full Text] [PDF]

				P. M. Okin, R. B. Devereux, M. S. Nieminen, S. Jern, L. Oikarinen, M. Viitasalo, L. Toivonen, S. E. Kjeldsen, B. Dahlof, and for the LIFE Study Investigators Electrocardiographic Strain Pattern and Prediction of New-Onset Congestive Heart Failure in Hypertensive Patients: The Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) Study Circulation, January 3, 2006; 113(1): 67 - 73. [Abstract] [Full Text] [PDF]

				J.-P. Smedema, G. Snoep, M. P. G. van Kroonenburgh, R.-J. van Geuns, E. C. Cheriex, A. P. M. Gorgels, and H. J. G. M. Crijns The Additional Value of Gadolinium-Enhanced MRI to Standard Assessment for Cardiac Involvement in Patients With Pulmonary Sarcoidosis Chest, September 1, 2005; 128(3): 1629 - 1637. [Abstract] [Full Text] [PDF]

				P. M. Okin, M. J. Roman, L. G. Best, E. T. Lee, J. M. Galloway, B. V. Howard, and R. B. Devereux C-Reactive Protein and Electrocardiographic ST-Segment Depression Additively Predict Mortality: The Strong Heart Study J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1787 - 1793. [Abstract] [Full Text] [PDF]

				P. M. Okin, R. B. Devereux, M. S. Nieminen, S. Jern, L. Oikarinen, M. Viitasalo, L. Toivonen, S. E. Kjeldsen, S. Julius, S. Snapinn, et al. Electrocardiographic Strain Pattern and Prediction of Cardiovascular Morbidity and Mortality in Hypertensive Patients Hypertension, July 1, 2004; 44(1): 48 - 54. [Abstract] [Full Text] [PDF]

				L. Oikarinen, M. S. Nieminen, M. Viitasalo, L. Toivonen, S. Jern, B. Dahlof, R. B. Devereux, P. M. Okin, and for the LIFE Study Investigators QRS Duration and QT Interval Predict Mortality in Hypertensive Patients With Left Ventricular Hypertrophy: The Losartan Intervention for Endpoint Reduction in Hypertension Study Hypertension, May 1, 2004; 43(5): 1029 - 1034. [Abstract] [Full Text] [PDF]

				P. M. Okin, M. J. Roman, E. T. Lee, J. M. Galloway, B. V. Howard, and R. B. Devereux Combined Echocardiographic Left Ventricular Hypertrophy and Electrocardiographic ST Depression Improve Prediction of Mortality in American Indians: The Strong Heart Study Hypertension, April 1, 2004; 43(4): 769 - 774. [Abstract] [Full Text] [PDF]

				V. Palmieri, P. M. Okin, J. N. Bella, E. Gerdts, K. Wachtell, J. Gardin, V. Papademetriou, M. S. Nieminen, B. Dahlof, and R. B. Devereux Echocardiographic Wall Motion Abnormalities in Hypertensive Patients With Electrocardiographic Left Ventricular Hypertrophy: The LIFE Study Hypertension, January 1, 2003; 41(1): 75 - 82. [Abstract] [Full Text] [PDF]

				P. M. Okin, R. B. Devereux, R. R. Fabsitz, E. T. Lee, J. M. Galloway, and B. V. Howard Quantitative assessment of electrocardiographic strain predicts increased left ventricular mass: the strong heart study J. Am. Coll. Cardiol., October 16, 2002; 40(8): 1395 - 1400. [Abstract] [Full Text] [PDF]