Predictors of Future Heart Failure in Men, Women

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Electrocardiographic sign of left ventricular hypertrophy was found to predict HF among women.

Electrocardiographic (ECG) sign of left ventricular hypertrophy (LVH) was found to predict HF among women and abnormal Q-waves, inferolateral T-wave inversions, and elevated heart rate were predictors in men, according to a study published in The American Journal of Cardiology.

In this large, prospective mobile clinic health survey, data from 10,864 individuals (51% men) were collected between 1966 and 1972 in Finland. Participants were assessed by standard resting 12-lead ECG recorded on paper at a speed of 50 mm/s. Information on hospitalizations and diagnoses were collected through the end of 2011 through the nationwide registry maintained by the National Institute for Health and Welfare.

At the study conclusion, a total of 1743 individuals were hospitalized due to HF. The hospitalizations occurred at an average of 23.7±11.2 years after baseline electrocardiogram. Neither the overall percentages of individuals with HF (women, 17% vs men, 16%) nor the yearly incidence rates of HF (women0.69% vs men, 0.75%; P =.639) differed on the basis of sex. Men had a greater risk for HF hospitalization compared with women (hazard ratio [HR], 1.2; 95% CI, 1.1-1.3; P =.004) and women tended to be older upon hospital admittance compared with men (75±11 years vs 70±11 years, respectively; P <.001).

Baseline characteristics that significantly correlated with HF in this cohort were age, body mass index, blood pressure, and prior history of cardiac disease (P <.001 for all).

After correcting for significant cofactors, ECG sign of LVH (P <.001) and atrial fibrillation (P <.001) in women, and atrial fibrillation (P <.001), T-wave inversion (P <.001), abnormal Q-waves (P =.002), and heart rate (P =.008) in men remained significant predictors of future HF.

After hospitalization for HF, 76% of women (P <.001) and 82% of men (P <.001) died. All-cause mortality was higher in individuals with vs without HF (women, 42%; P <.001; men, 61%; P <.001).

“[T]he present data show that if LVH is observed in a standard 12-lead [ECG] in a middle-aged woman, emphasis should be put on adequate treatment of hypertension or diagnosing other possible causes of LVH to prevent future HF,” noted the study authors.


Haukilahti M A E, Kenttä T V, Tikkanen J T, et al. Electrocardiographic risk markers for heart failure in women vs men. [Published online June 17, 2020] Am J Cardiol. doi:10.1016/j.amjcard.2020.06.018