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Background: While atrial fibrillation is a well established cause of stroke, a strong association has been previously postulated between left ventricular hypertrophy (LVH) and stroke. The prevalence and significance of LVH by electrocardiogram in stroke patients, however, is not clear.Objectives: To examine the prevalence of left ventricular hypertrophy by electrocardiographic (EKG) criteria, versus atrial fibrillation or flutter, in patients receiving an EKG for a diagnosis of stroke.Methods: An EKG database from a university cardiology noninvasive lab was examined for the diagnosis of stroke or CVA over a one year period. The EKGs were evaluated for the presence of LVH or atrial fibrillation/flutter. The results were analyzed using a categorical Chi square test.Results: There was a total of 14,798 EKGs performed over one year, 1,439 of which reported LVH (9.7%). There were 272 EKGs with a diagnosis of acute stroke or CVA (1.7% of total EKGs). Out of these, there were 174 EKGs in sinus rhythm without LVH (64%), 78 EKGs in sinus rhythm with LVH (29%, P < 0.05), and 20 EKGs in atrial fibrillation or atrial flutter (7.4%).Discussion: Stroke is major health problem associated with increased mortality and morbidity. Hypertension is a well established risk factor for stroke in addition to cardiovascular events, and when long-standing and uncontrolled, causes left ventricular hypertrophy on EKG. In our cohort nearly one third of patients with stroke were in sinus rhythm, but had left ventricular hypertrophy by EKG, a prevalence that was four time that of atrial fibrillation or atrial flutter, and three time the prevalence of LVH in the overall database. Therefore, LVH by EKG appears to predict an increased risk of stroke, and thereby need for aggressive work-up and risk factor modification. Further studies to examine blood pressure and other cardiovascular risk factors as correlates of LVH on EKG will help shed further light on this important observation.