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Left ventricular hypertrophy by ECG versus cardiac MRI as a predictor for heart failure
  1. Abdullahi O Oseni1,
  2. Waqas T Qureshi1,
  3. Mohamed F Almahmoud1,
  4. Alain G Bertoni2,
  5. David A Bluemke3,
  6. William G Hundley1,
  7. Joao A C Lima4,
  8. David M Herrington1,
  9. Elsayed Z Soliman1,2
  1. 1Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
  2. 2Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
  3. 3Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, Maryland, USA
  4. 4Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Abdullahi O Oseni, Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; aoseni{at}


Objective To determine if there is a significant difference in the predictive abilities of left ventricular hypertrophy (LVH) detected by ECG-LVH versus LVH ascertained by cardiac MRI-LVH in a model similar to the Framingham Heart Failure Risk Score (FHFRS).

Methods This study included 4745 (mean age 61±10 years, 53.5% women, 61.7% non-whites) participants in the Multi-Ethnic Study of Atherosclerosis. ECG-LVH was defined using Cornell voltage product while MRI-LVH was derived from left ventricular mass. Cox proportional hazard regression was used to examine the association between ECG-LVH and MRI-LVH with incident heart failure (HF). Harrell's concordance C-index was used to estimate the predictive ability of the model when either ECG-LVH or MRI-LVH was included as one of its components.

Results ECG-LVH was present in 291 (6.1%), while MRI-LVH was present in 499 (10.5%) of the participants. Both ECG-LVH (HR 2.25, 95% CI 1.38 to 3.69) and MRI-LVH (HR 3.80, 95% CI 1.56 to 5.63) were predictive of HF. The absolute risk of developing HF was 8.81% for MRI-LVH versus 2.26% for absence of MRI-LVH with a relative risk of 3.9. With ECG-LVH, the absolute risk of developing HF 6.87% compared with 2.69% for absence of ECG-LVH with a relative risk of 2.55. The ability of the model to predict HF was better with MRI-LVH (C-index 0.871, 95% CI 0.842 to 0.899) than with ECG-LVH (C-index 0.860, 95% CI 0.833 to 0.888) (p<0.0001).

Conclusions ECG-LVH and MRI-LVH are predictive of HF. Substituting MRI-LVH for ECG-LVH improves the predictive ability of a model similar to the FHFRS.

  • ECG/electrocardiogram

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  • Twitter Follow Abdullahi Oseni at @drabdul

  • Acknowledgments The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at In addition, research reported in this publication was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number T32HL076132. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Contributors AOO, DMH, AGB and EZS planned the study and primarily wrote the manuscript. WTQ and MFA did the primary statistical analysis and contributed to the writing and editing. JACL, DMH and DAB conducted the MRI protocol in the MESA study and guided the study from the conception of the idea to the final written manuscript. All the authors reviewed and approved the final manuscript, response to the reviewers and final revision.

  • Funding This research was supported by contracts N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute and by grants UL1-TR-000040 and UL1-TR-001079 from National Center for Research Resources.

  • Competing interests None declared.

  • Ethics approval Wake Forest school of Medicine Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.