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Background Patients with left ventricular hypertrophy (LVH) have an increased risk of ischemic stroke. Although echocardiography is commonly used for the diagnosis of LVH, there is little information about the potential role of electrocardiography in providing additional prognostic information. The purpose of this study is to determine if electrocardiographically derived criteria for LVH provide additional prognostic value over echocardiography for predicting ischemic stroke in a multiethnic population. Methods A population-based, case-control study was conducted in 177 patients who had had a first ischemic stroke and in 246 control patients matched for age, gender, and race or ethnicity. Left ventricular mass was measured by using 2-dimensional transthoracic echocardiography. Logistic regression analysis was performed to assess the risk of stroke associated with the presence of LVH diagnosed by electrocardiography (defined by 4 established criteria) after adjustment for the presence of other stroke risk factors and for echocardiographically determined LVH. Results After adjustment for the presence of other established stroke risk factors, ECG-LVH was associated with ischemic stroke, using Sokolow-Lyon (odds ratio [OR] 2.12, 95% CI 1.05-4.30), Cornell voltage (OR 2.06, 95% CI, 1.26-3.35), and Cornell product criteria (OR 2.12, 95% CI, 1.13-3.97). Cornell voltage criterion (men, >2.8mV; women, >2.0mV) was associated with ischemic stroke even after adjustment for echocardiographically determined LVH (OR 1.73, 95% CI, 1.04-2.88). The combination of echo-LVH and a positive Cornell voltage criterion was associated with a 3.5-fold increase in stroke risk. Conclusions Our study indicates that the presence of ECG-LVH is associated with an increased risk of ischemic stroke after adjustment for other stroke risk factors. For Cornell voltage criteria, this relationship persisted even after adjustment for echocardiographic LVH. Electrocardiographic results can provide independent information for left ventricular myocardial changes and should be considered together with echocardiographic results to fully assess the risk of ischemic stroke.

In previous studies the rate of left ventricular (LV) volume change during the first third of systole was shown to be a more sensitive index of cardiac performance than ejection fraction (EF) in coronary disease. To test the hypothesis that a noninvasive index of the ejection rate in early systole can also identify subtle abnormalities of LV performance in aortic regurgitation (AR), the rate of change of LV counts during the first third of systole was measured by first-pass radionuclide angiography (RNV) in 34 AR patients and in 10 normal controls. By least squares analysis a straight line was fit to the LV counts obtained at 0.025 second intervals during the first third of systole; the slope was divided by the average counts in the first third to give a rate constant (RC) proportional to LV volume change during early systole. The AR patients were divided into two groups based upon the response of EF to exercise (ΔEF). A normal response was defined as a rise equal to or greater than 5%. Group 1 comprised 19 AR patients with a normal EF response to exercise (from 60 ± 9% to 70 ± 9%), and group 2 comprised 15 AR patients with an abnormal EF response to exercise (from 58 ± 9% to 52 ± 10%). The RC obtained at rest was 9.4 ± 2.8 for group 2, significantly lower than for group 1 (15.6 ± 3.9) or controls (14.9 ± 2.6) (p 12.0. When RC was plotted vs EF for all 44 individuals, there was a significant direct relationship, r = 0.74 (p < 0.01), but with wide confidence limits. These data indicate that a noninvasive index of the rate of LV volume change during the first third of systole can identify abnormal LV reserve in AR patients with normal EF at rest.