Aim: To evaluate the diagnostic reliability of the ECG diagnosis of left-ventricular hypertrophy (LVH) in a cohort of elderly subjects taken from a general population. Patients: The 447 subjects with perfect echocardiography and ECG results of the 2,254 included in the Cardiovascular Study in the Elderly. Methods: Sensitivity, specificity, positive and negative predictive value of the most commonly used ECG tests of LVH were calculated versus the gold standard, echocardiography. Results: All ECG tests had a very low sensitivity. Furthermore, except for the Cornell index and (at least in the normotensives) the Minnesota code, they were not able to demonstrate the higher prevalence of LVH in elderly females in comparison to males. The predictive value of ECG was constantly higher in males than females when negative; when positive, some tests were more predictive in males, some in females, and in others, equally predictive in both sexes. Conclusions: ECG is not a reliable method for screening LVH in elderly populations. Echocardiography and ECG give different information, and their reliability may be different if positive or negative.

The prognostic value of electrocardiographic abnormalities has not been widely studied in the elderly. We examined the Minnesota code ECG items in 2254 elderly subjects of the Cardiovascular Study in the Elderly (CASTEL), performed on an Italian general population. In our experience, codes for ischaemia, 1st-degree atrio-ventricular block, bundle branch blocks, myocardial infarction, atrial fibrillation or sinus tachycardia were predictors of overall mortality in females, while only the former three items were predictors in men. Although ischaemia, left bundle branch block and atrial fibrillation were predictors of cardiovascular mortality in both sexes, right bundle branch block, supraventricular arrhythmias and left ventricular hypertrophy were predictors only in men, and 1st-degree atrio-ventricular block were predictors only in women. Surprisingly, left anterior haemiblock and bifascicular blocks were not predictive of mortality. (Jpn Heart J 34: 567-577, 1993) Key Word: Minnesota code Elderly ECG Epidemiology LTHOUGH the prevalence and prognostic value of electrocardiographic abnormalities have been widely studied since the 1960s,1)-6) elderly populations have usually been excluded from major studies. As a result, only fragmentary information derived from anecdotic descriptions or recent reports7)-12) are available on this age class.The Pipberger method,13)-15) the Washington Code16) (both based on Frank leads) and the Minnesota code (based on standard leads)17)-19) have been employed to study ECG in populations. Despite a low sensitivity of some

Backgroundand hypothesis: The prognostic value of exercise technetium 99m sestamibi single-photon emission computed tomography (SPECT) imaging in patients with previous bypass surgery is unknown. The aim of our study was to assess the prognostic information obtained with exercise scintigraphy performed for routine follow-up or reappearance of symptoms.Methods: We studied 75 patients referred to our Center at a mean of 38 2 53 months from the revascularization procedure and prospectively followed them for 38 -c 24 months.Results: Fifteen patients (20%) had events at follow-up:there were 4 cardiac deaths, 3 nonfatal acute myocardial in- Conclusions: Exercise sestamibi SPECT scintigraphy provides optimal prognostic information after clinical and ergometric parameters in patients with previous bypass surgery.

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