University of Oulu

Kimmo Porthan, Tuomas Kenttä, Teemu J. Niiranen, Markku S. Nieminen, Lasse Oikarinen, Matti Viitasalo, Jussi Hernesniemi, Antti M. Jula, Veikko Salomaa, Heikki V. Huikuri, Christine M. Albert, Jani T. Tikkanen, ECG left ventricular hypertrophy as a risk predictor of sudden cardiac death, International Journal of Cardiology, Volume 276, 2019, Pages 125-129, ISSN 0167-5273,

ECG left ventricular hypertrophy as a risk predictor of sudden cardiac death

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Author: Porthan, Kimmo1; Kenttä, Tuomas2; Niiranen, Teemu J.3,4;
Organizations: 1Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
2Research Unit of Internal Medicine, University Hospital of Oulu, University of Oulu, Finland
3THL-National Institute for Health and Welfare, Turku, Finland
4THL-National Institute for Health and Welfare, Helsinki, Finland
5Heart Center, Tampere University Hospital, Tampere, Finland
6Faculty of Medicine and Life Sciences, University of Tampere, Finland
7Division of Preventive Medicine, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.4 MB)
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Language: English
Published: Elsevier, 2019
Publish Date: 2021-11-24


Background: Electrocardiographic (ECG) left ventricular hypertrophy (LVH) is an established risk factor for cardiovascular events. However, limited data is available on the prognostic values of different ECG LVH criteria specifically to sudden cardiac death (SCD). Our goal was to assess relationships of different ECG LVH criteria to SCD.

Methods: Three traditional and clinically useful (Sokolow–Lyon, Cornell, RaVL) and a recently proposed (Peguero–Lo Presti) ECG LVH voltage criteria were measured in 5730 subjects in the Health 2000 Survey, a national general population cohort study. Relationships between LVH criteria, as well as their selected composites, to SCD were analyzed with Cox regression models. In addition, population-attributable fractions for LVH criteria were calculated.

Results: After a mean follow-up of 12.5 ± 2.2 years, 134 SCDs had occurred. When used as continuous variables, all LVH criteria except for RaVL were associated with SCD in multivariable analyses. When single LVH criteria were used as dichotomous variables, only Cornell was significant after adjustments. The dichotomous composite of Sokolow–Lyon and Cornell was also significant after adjustments (hazard ratio for SCD 1.82, 95% confidence interval 1.20–2.70, P = 0.006) and was the only LVH measure that showed statistically significant population-attributable fraction (11.0%, 95% confidence interval 1.9–19.2%, P = 0.019).

Conclusions: Sokolow–Lyon, Cornell, and Peguero–Lo Presti ECG, but not RaVL voltage, are associated with SCD risk as continuous ECG voltage LVH variables. When SCD risk assessment/adjustment is performed using a dichotomous ECG LVH measure, composite of Sokolow–Lyon and Cornell voltages is the preferred option.

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Series: International journal of cardiology
ISSN: 0167-5273
ISSN-E: 0167-5273
ISSN-L: 0167-5273
Volume: 276
Pages: 125 - 129
DOI: 10.1016/j.ijcard.2018.09.104
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This work was supported by grants from the Academy of Finland (T.K., project number 309447), the Finnish Foundation for Cardiovascular Research (K.P., V.S.), the Finnish Medical Foundation(K.P.), the Orion Research Foundation (K.P., T.K.), and the Paulo Foundation (T.K.).
Academy of Finland Grant Number: 309447
Detailed Information: 309447 (Academy of Finland Funding decision)
Copyright information: © 2018 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (