A prognostic comparison of asymptomatic left ventricular hypertrophy and unrecognized myocardial infarction: the Framingham Study

Am Heart J. 1986 Feb;111(2):391-7. doi: 10.1016/0002-8703(86)90156-0.


In 30 years of follow-up in the Framingham study, routine biennial ECG examinations revealed 315 subjects with ECG-LVH and 164 with unrecognized ECG-MI without previous cardiac explanation. Among subjects initially free of clinically evident coronary heart disease and both ECG abnormalities, the incidence of ECG-LVH was about double that of ECG-MI. Both events exhibited a male predominance and hypertensive subjects were more vulnerable to each. In subjects with asymptomatic ECG-LVH and ECG-MI, the 10-year, age-adjusted incidence of clinical coronary heart disease was greater than the rate experienced by the general Framingham sample. Rates for ECG-LVH were almost as large as those for ECG-MI. Cardiac failure and stroke also occurred more frequently among subjects with either ECG abnormality, and rates for ECG-LVH exceeded those for ECG-MI. Death from coronary heart disease, and sudden death in particular, was also increased two- to fourfold with similar risks for ECG-LVH and ECG-MI. ECG-LVH carried a significantly greater risk than ECG-MI for cardiovascular deaths in women. These findings suggest that ECG-LVH and ECG-MI are similar subclinical events with respect to predisposing characteristics and prognosis for subsequent overt cardiovascular disease including clinical manifestations of coronary heart disease.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Cardiomegaly / epidemiology*
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / mortality
  • Cerebrovascular Disorders / epidemiology
  • Coronary Disease / epidemiology
  • Coronary Disease / mortality
  • Death, Sudden / epidemiology
  • Electrocardiography*
  • Female
  • Follow-Up Studies
  • Heart Failure / epidemiology
  • Humans
  • Hypertension / complications
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology*
  • Prognosis
  • Prospective Studies
  • Risk