LVH is traditionally believed to be adverse marker for both coronary events and cardiac failure. . (Framingham ) While this may be true most of time we also have evidence to suggest patients with LVH tolerate ischemic injury better.The area of MI is less. In fact , the coronary drug project was not able to identify LVH as a major risk factor for MI. But many other studies continued to portray LVH dangerous parameter in ACS.
This paper from Sheba medical center Israel tries to answer this question succinctly !
LVH indeed is an adverse predictor for cardiac outcome in the long term.Meanwhile , since the 7 day mortality of STEMI is well below 3% if associated with LVH keeps the controversy alive ( 5-7% in non LVH group ) .This piece of statistics gives credibility to the belief LVH may really prevent early deaths in STEMI.
This phenomenon about LVH is consistent with our observation in one of the Asia’s oldest coronary care units (Started in 1972) .None of the STEMI patients with LVH had a cardiogenic shock in the recent past !
* It is important to realise not all LVH are same. Inherited LVH, Diabetic LVH and uremic( or sub uremic ) LVH behave differently. Since the concept of LVH is carried by physicians in a single basket , we tend to miss the true benefits of LVH that occur purely due to good exercise training or a mild HT !
In other words , LVH that do not involve interstitial proliferation is probably good for the heart !
With due regards to Framingam study , presence of LVH in ECG in any form of acute coronary syndrome should bring a sense of comfort in the coronary care units .I agree , it may increase risk of sudden death in some of the population but still it has some unique and definite advantages at times of ACS.
1 Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic
implications of echocardiographically determined left ventricular mass in the
Framingham Heart Study. N Engl J Med 1990;322:1561–1566
2.The Coronary Drug Project Research Group. Left ventricular hypertrophy patterns and prognosis. Experienced post infarction in the Coronary Drug Project.Circulation 1974;49:862–869.
3.Behar S, Reicher-Reiss H, Abinadar E, Agmon J, Barzilai J, Friedman Y, Kaplinsky E, Kauli N, Kishon Y, Palant A. Long-term prognosis after acute myocardial infarction in patients with left ventricular hypertrophy on the
electrocardiogrm. Am J Cardiol 1992;69:985–990.
*Coronary drug project (A old study done in early 1970s has more credibility when LVH was not considered as pharma target !)
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