Development and validation of a clinical score to identify echo cardiographic left ventricular hypertrophy in patients with cardiovascular disease

BACKGROUND

Echocardiographic (echo) left ventricular hypertrophy (LVH) is an independent predictor of mortality. Despite this, screening for LVH in patients with overt cardiovascular diseases is not universally done. To help target echo screening for LVH in patient population, we developed and validated a simple clinical score to help identify those likely to have echo LVH.

METHODS

We performed two studies. The development cohort consisted of 267 patients with angina. The validation cohort consisted of 227 patients with peripheral arterial disease.

RESULTS

The prevalence of echo LVH in both patient cohorts was 50%. Six independent predictors of LVH were identified in the development cohort: age >65 years (1 point), body mass index >30 kg/m(2) (1 point), history of hypertension (1 point), previous myocardial infarction (1 point), clinic blood pressure >130/80 mm Hg (1 point) and bundle branch block (BBB) on electrocardiogram (4 points). Our clinical score was strongly associated with the presence of LVH in the validation cohort. It also showed a significant continuous positive relationship (P trend <0.001 in males and P trend = 0.006 in females) with increasing quartiles of LV mass in both cohorts. In those without BBB, a modified clinical score performed equally well.

CONCLUSION

We have developed a simple clinical score which quantifies the chance that any patient with manifest cardiovascular disease has the added risk factor of LVH. This will help target precious echo resources toward individuals who are most likely to have this condition. This could potentially lead to better risk stratification in this patient population.