Newly developed ST-T abnormalities on the electrocardiogram and chronologic changes in cardiovascular risk factors

Electrocardiographic abnormalities and home blood pressure in treated elderly hypertensive patients: Japan home versus office blood pressure measurement evaluation in the elderly (J-HOME-Elderly) study

This study compares relationships between each of morning home blood pressure (BP), evening home BP and office BP with electrocardiographic (ECG) abnormalities among treated hypertensive Japanese patients. We defined ECG left ventricular hypertrophy (LVH) as Sokolow-Lyon voltage and/or Cornell voltage duration product. Abnormal T waves and ST segment depression were categorized based on the Minnesota code. Office BP was calculated as the mean of four readings taken during two visits. Morning and evening home BP were calculated as the mean of five readings measured once each morning and evening for 5 days, respectively. Multivariate analysis showed that ECG-LVH in 747 hypertensives (mean age: 72 years; women: 63%) was more closely associated with morning home BP than with either office or evening home BP. Even the first reading of morning home BP on day 1 was significantly associated with ECG-LVH independently of office BP. The association between home BP and ECG-LVH increased with the cumulative number of home BP measurements. The results for abnormal T waves were similar. Home and office BP did not significantly differ between patients with and without ST segment depression. Morning home BP was more closely associated with ECG-LVH and abnormal T waves than either office or evening home BP among treated hypertensive Japanese patients.

Prognosis following acute myocardial infarction in patients with ST-T abnormalities on electrocardiograms obtained before myocardial infarction

BACKGROUND

Many studies have examined the relationship between prognosis after myocardial infarction (MI) and electrocardiographic (ECG) findings at the time of or after the onset of MI. However, little work has been done concerning the association between ECG findings obtained before the onset of MI (pre-MI) and the prognosis after MI.

HYPOTHESIS

The study was undertaken to determine whether ST-T segment and T-wave morphology on pre-MI ECGs provides useful information for prognosis after acute MI.

METHODS

Pre-MI ECGs of 212 patients recorded within the 6-month period before MI were studied for the presence of high-voltage R waves, ST-segment depression, and negative T waves. The Kaplan-Meier method and multivariate analysis were used to determine the relationship between these ECG findings and in-hospital cardiac death.

RESULTS

In-hospital cardiac death occurred in 32 (15.1%) patients. The in-hospital mortality rate was 38.5% (5/13) for the patients with high-voltage R waves, 54.5% (6/11) for patients with ST-segment depression, and 45.6% (15/33) for patients with negative T waves. The in-hospital mortality rate was 13.6% (27/199) for patients without high-voltage R waves, 12.9% (26/201) for patients without ST-segment depression, and 9.5% (17/179) for those without negative T waves. Multivariate analysis identified age and negative T waves as independent risk factors for cardiac death, with a hazard ratio for negative T waves of 3.1.

CONCLUSION

Negative T waves on pre-MI ECGs represent an independent predictor of in-hospital cardiac death in patients with MI.

Relation of electrocardiographic left ventricular hypertrophy with and without T-wave changes to systemic blood pressure, body mass, and serum lipids and blood glucose levels in Japanese men

Left ventricular (LV) hypertrophy, especially combined with an abnormal ST-T, is considered 1 of many coronary risk factors. Seven hundred forty-nine Japanese men were selected according to their electrocardiographic findings, i.e., normal electrocardiogram, LV hypertrophy without an abnormal ST-T segment, LV hypertrophy with a flat T wave, and LV hypertrophy with a negative T wave. Coronary risk factors were compared among these 4 age-matched groups. Groups with LV hypertrophy with negative or flat T waves had larger body mass index (24.9 vs 22.9 kg/m2), higher mean systemic blood pressure (111 vs 95 mm Hg), larger LV mass (265 vs 157 g), higher blood glucose (110 vs 100 mg/dl), higher serum triglyceride (148 vs 122 mg/dl), higher total cholesterol (206 vs 198 mg/dl), and lower high-density lipoprotein cholesterol (47 vs 54 mg/dl) than the normal group or the group with LV hypertrophy without T-wave change. Among these risk factors, blood pressure and glucose remained higher even after the adjustment by body mass index or by body mass index and blood pressure. Electrocardiographic LV hypertrophy with a changed T wave signified higher risk of coronary artery disease in Japanese men.