Prognostic value of different electrocardiographic criteria for left ventricular hypertrophy in Chinese community-dwelling older adults

Objective: The predictive value of different single electrocardiographic left ventricular hypertrophy (ECG-LVH) criteria and their combined indices for long-term all-cause and cardiovascular mortality in Chinese community-dwelling populations remains understudied. Methods: 6016 participants aged ≥60 years from a Chinese community-based cohort free of prior cardiovascular events at baseline were followed up for 9.39 years (median). LVH was diagnosed using five individual criteria: the traditional Sokolow-Lyon, Cornell Voltage, Cornell Product, and RavL criteria and the recently proposed Peguero-Lo Presti (PLP) criterion. Two composite indices were constructed either with any of the four traditional criteria, or any of the four traditional criteria and the PLP criterion. Cox regression models were used to analyze the associations of these individual and composite indices with all-cause and cardiovascular mortality. Results: Three individual ECG-LVH criteria (Cornell Voltage, Cornell Product and PLP) and two composite indices were associated with both all-cause mortality (HR range: 1.25–1.81, all P < 0.05) and cardiovascular mortality (HR range: 1.50–2.27, all P < 0.05). The novel PLP and composite indices yielded a significant net reclassification improvement (NRI) (all-cause mortality, NRI = 0.1116–0.1176; cardiovascular mortality, NRI = 0.1675–0.1948; all P < 0.010), with a mild improvement in discrimination (C-index change, 0.0146–0.0171) and non-significant integrated discrimination improvement (IDI). Conclusion: The PLP and composite ECG-LVH criteria were associated with long-term mortality and provided modest incremental risk reclassification. External validation, structural cardiac assessment and evaluation of calibration and clinical net benefit are required before these approaches can be recommended for community screening.