Electrocardiography for Assessment of Hypertensive Heart Disease: A New Role for an Old Tool

Left ventricular (LV) hypertrophy (LVH), detectedeither by electrocardiography (ECG) or echocardiography(ECHO), has long been recognized as a powerfulpredictor of serious cardiovascular (CV) sequelae.Avery large and highly consistent body of evidenceindicates that LVH is not only an adaptation toincreased hemodynamic load in hypertension, but isalso independently associated with an enhanced risk formyocardial infarction, cardiac sudden death, congestiveheart failure, and stroke in the general population, aswell as in patients with systemic hypertension, coronaryheart disease, chronic kidney disease, and atrial fibrillation. Intriguingly, the cumulative incidence ofcardiovascular events increases progressively withincreasing LV mass (LVM), without evidence of anythreshold separating the postulated “compensatory”from “pathological” LVH. In other words, patientswith LVM in the upper-normal range already haveincreased risk for CV events.