We tested the prognostic value of a new electrocardiographic (ECG) method (Perugia
score) for diagnosis of left ventricular hypertrophy (LVH) in essential hypertension
and compared it with five standard methods (Cornell voltage, Framingham criterion,
Romhilt-Estes point score, left ventricular strain, Sokolow-Lyon voltage).
Several standard ECG methods for assessment of LVH are used in the clinical setting,
but a comparative prognostic assessment is lacking.
A total of 1,717 white hypertensive subjects (mean age 52 years; 51% men) were prospectively
followed up for up to 10 years (mean 3.3).
At entry, the prevalence of LVH was 17.8% (Perugia score), 9.1% (Cornell), 3.9% (Framingham),
5.2% (Romhilt-Estes), 6.4% (strain) and 13.1% (Sokolow-Lyon). During follow-up there
were 159 major cardiovascular morbid events (33 fatal). The event rate was higher
in the subjects with than in those without LVH (all p < 0.001) according to all methods
except the Sokolow-Lyon method. By multivariate analysis, an independent association
between LVH and cardiovascular disease risk was maintained by the Perugia score (hazard
ratio [HR] 2.04, 95% confidence interval [CI] 1.5 to 2.8) and the Framingham (HR 1.91,
95% CI 1.1 to 3.2), Romhilt-Estes (HR 2.63, 95% CI 1.7 to 4.1) and strain methods
(HR 2.11, 95% CI 1.4 to 3.2). The Perugia score showed the highest population-attributable
risk for cardiovascular events, accounting for 15.6% of all cases, whereas the Framingham,
Romhilt-Estes and strain methods accounted for 3.0%, 7.4% and 6.8% of all events,
respectively. LVH diagnosed by the Perugia score was also associated with an increased
risk of cardiovascular mortality (HR 4.21, 95% CI 2.1 to 8.7), with a population-attributable
risk of 37.0%.
The Perugia score carried the highest population-attributable risk for cardiovascular
morbidity and mortality compared with classic methods for detection of LVH. Traditional
interpretation of standard electrocardiography maintains an important role for cardiovascular
risk stratification in essential hypertension.