Prevalence and prognostic implications of electrocardiographic left ventricular hypertrophy in heart failure:: evidence from the CHARM programme

Background: Electrocardiographic left ventricular hypertrophy ( ECG LVH) is a powerful independent predictor of cardiovascular morbidity and mortality in hypertension. Objective: To determine the contemporary prevalence and prognostic implications of ECG LVH in a broad spectrum of patients with heart failure with and without reduced left ventricular ejection fraction ( LVEF). Methods and outcome: The Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity ( CHARM) programme randomised 7599 patients with symptomatic heart failure to receive candesartan or placebo. The primary outcome comprised cardiovascular death or hospital admission for worsening heart failure. The relative risk ( RR) conveyed by ECG LVH compared with a normal ECG was examined in a Cox model, adjusting for as many as 31 covariates of prognostic importance. Results: The prevalence of ECG LVH was similar in all three CHARM trials ( Alternative, 15.4%; Added, 17.1%; Preserved, 14.7%; Overall, 15.7%) despite a more frequent history of hypertension in CHARM-Preserved. ECG LVH was an independent predictor of worse prognosis in CHARM-Overall. RR for the primary outcome was 1.27 ( 95% confidence interval ( CI) 1.04 to 1.55, p = 0.018). The risk of secondary end points was also increased: cardiovascular death, 1.50 ( 95% CI 1.13 to 1.99, p = 0.005); hospitalisation due to heart failure, 1.19 ( 95% CI 0.94 to 1.50, p = 0.148); and composite major cardiovascular events, 1.35 ( 95% CI 1.12 to 1.62, p = 0.002). Conclusion: ECG LVH is similarly prevalent in patients with symptomatic heart failure regardless of LVEF. The simple clinical finding of ECG LVH was an independent predictor of a worse clinical outcome in a broad spectrum of patients with heart failure receiving extensive contemporary treatment. Candesartan had similar benefits in patients with and without ECG LVH.