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Liu S, Zhang C, Wan J. The correlation between T-wave abnormalities and adverse cardiovascular events and echocardiographic changes in hypertensive patients. Clin Exp Hypertens 2023; 45:2185252. [PMID: 36863333 DOI: 10.1080/10641963.2023.2185252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Major adverse cardiovascular events (MACE) are common in patients with hypertension and are associated with higher mortality. METHODS This study aimed to observe the incidence of MACE in hypertensive patients and the correlation between the electrocardiogram (ECG) T-wave abnormalities and echocardiographic changes. This retrospective cohort study analyzed the incidence of adverse cardiovascular events and changes in echocardiographic features in 430 hypertensive patients admitted to Zhongnan Hospital of Wuhan University from January 2016 to January 2022. Patients were grouped according to a diagnosis of electrocardiographic T-wave abnormalities. RESULTS Compared with the normal T-wave group, the incidence of adverse cardiovascular events was significantly higher in hypertensive patients with abnormal T-wave (141 [54.9%] vs 120 [69.4%], x^2 = 9.113, P = .003). However, Kaplan-Meier survival curve showed that no survival advantage was observed in the normal T-wave group at all in the hypertensive patients (P = .83). Echocardiographic values associated with cardiac structural markers, including ascending aorta diameter (AAO), left atrial diameter (LA), and interventricular septal thickness (IVS), were significantly higher in the group with abnormal T-wave than those in the group with normal T-wave at baseline and follow-up (P <.05 for all). In addition, in an exploratory Cox regression analysis model stratified by clinical characteristics of hypertensive patients, the forest plot indicated that the variables, including the age (>65 years), hypertension history (>5 years), premature atrial beats, and severe valvular regurgitation were significantly associated with adverse cardiovascular events (P <.05). CONCLUSION Hypertensive patients with abnormal T-wave show a higher incidence of adverse cardiovascular events. The values of cardiac structural markers were significantly higher in the group with abnormal T-wave.
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Affiliation(s)
- Shengnan Liu
- Zhongnan Hospital of Wuhan University, Wuhan City, China
| | - Chao Zhang
- Zhongnan Hospital of Wuhan University, Wuhan City, China
| | - Jing Wan
- Zhongnan Hospital of Wuhan University, Wuhan City, China
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Kang J, Cho Y. Sex differences in the association between minor nonspecific ST-segment and T-wave abnormalities and coronary artery calcification. Atherosclerosis 2023; 384:117154. [PMID: 37316434 DOI: 10.1016/j.atherosclerosis.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND AIMS Although minor nonspecific ST-segment and T-wave abnormalities (NSSTTA) have been associated with adverse cardiovascular outcomes, their relationship with subclinical atherosclerosis remains controversial. Therefore, the associations between electrocardiographic (ECG) abnormalities, including NSSTTA, and coronary artery calcification (CAC) were investigated in this study. METHODS This cross-sectional study included 136,461 Korean participants with no known cardiovascular disease or cancer, who underwent a health checkup including ECG and computed tomography to measure the coronary artery calcium score (CACS) by Agatston method between 2010 and 2018. ECG abnormalities were defined in accordance with the Minnesota Code using an automated ECG analysis program. A multinomial logistic regression model was used to calculate prevalence ratios (PRs) with 95% confidence intervals (CI) for each CACS category. RESULTS In men, both NSSTTA and major ECG abnormalities were associated with all levels of CACS. The multivariable-adjusted PRs (95% CI) for CACS >400 comparing NSSTTA and major ECG abnormalities to the reference (neither NSSTTA nor major ECG abnormalities) were 1.88 (1.29-2.74) and 1.50 (1.18-1.91), respectively. Women with major ECG abnormalities were more likely to have a CACS of 101-400, the PRs (95% CI) comparing major ECG abnormalities to the reference group was 1.75 (1.18-2.57). NSSTTA were not associated with any CACS level in women. CONCLUSIONS NSSTTA and major ECG abnormalities are associated with CAC in men, though NSSTTA were not associated with CAC in women, suggesting that NSSTTA should be considered sex-specific risk factors for coronary artery disease in men, but not in women.
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Affiliation(s)
- Jeonggyu Kang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 04514, Republic of Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, 06355, Republic of Korea
| | - Yongkeun Cho
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, 41944, Republic of Korea.
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Zhan X, Zeng C, He J, Wang M, Xiao J. Non-specific electrocardiographic ST-T abnormalities predict mortality in patients on peritoneal dialysis. Front Cardiovasc Med 2022; 9:930517. [PMID: 36588547 PMCID: PMC9798218 DOI: 10.3389/fcvm.2022.930517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Background This study aimed to evaluate the predictive value of non-specific ST-segment and/or T-wave abnormalities in electrocardiography (ECG) for all-cause and cardiovascular mortality (CVM) in peritoneal dialysis (PD) patients. Methods All patients who started PD between November 1, 2005, and February 28, 2017, at the First Affiliated Hospital of Nanchang University were enrolled. The primary outcomes were all-cause mortality and CVM. The Kaplan-Meier method and a log-rank test were used for the survival analysis. Multivariate Cox proportional hazards models were used to investigate the risk factors for all-cause mortality and CVM. Results A total of 724 eligible PD patients were enrolled, including 401 (55.4%) men. In total, 153 (21.1%) patients died during a mean follow-up period of 27 (interquartile range, 13-41) months, and cardiovascular death was responsible for 84 of these deaths. The patients with non-specific ST-T abnormalities (NSSTTAs) had lower overall and cardiovascular survival rates compared to those free from any ECG abnormalities. According to the multivariate Cox proportional hazards models, (NSSTTAs) are independent risk factors for all-cause mortality and CVM, the hazard ratios are 1.81 (95% confidence interval, 1.11-2.95; p = 0.017) and 2.86 (95% confidence interval, 1.52-5.37; p = 0.001), respectively. Conclusion Non-specific ST-T abnormalities can serve as risk markers of all-cause and CVM in PD patients.
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Affiliation(s)
- Xiaojiang Zhan
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Chuanfei Zeng
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Jiajing He
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Menghui Wang
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Jun Xiao
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China,*Correspondence: Jun Xiao,
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Minor ST-T changes on electrocardiograms are associated with reduced constructive myocardial work in hypertensive patients with a preserved ejection fraction. Hypertens Res 2022; 45:1373-1381. [PMID: 35715514 DOI: 10.1038/s41440-022-00957-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/15/2022] [Accepted: 05/03/2022] [Indexed: 11/08/2022]
Abstract
Minor ST-T changes on electrocardiograms are observed in patients with hypertensive heart disease with a preserved left ventricular ejection fraction (LVEF); however, the relationship between minor ST-T changes and global myocardial work on echocardiograms remains unclear. We evaluated the global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) in 186 hypertensive patients with preserved LVEF (>50%) using an offline analysis system (View Pal, GE). Minor ST-T changes as well as major ST-T changes (depression in ST in lead V5 > 1 mV) were also evaluated by electrocardiography. The mean age was 79.4 ± 8.2 years (men 37.6%). Patients with minor and major ST-changes had a smaller absolute GLS (-20.3 ± 3.1, -18.2 ± 3.7, and -15.2 ± 5.0%, P < 0.001) and a smaller constructive workload [GWI (2148 ± 486, 1938 ± 462, and 1685 ± 701 mmHg%, P = 0.002) and GCW (2419 ± 510, 2185 ± 466, and 1865 ± 702 mmHg%, P < 0.001)] than those with no ST-T changes. Additionally, patients with minor and major ST-T changes had increased wasted myocardial work [GWW (87 ± 61, 105 ± 56, and 127 ± 75 mmHg%, P = 0.045)], which resulted in reductions in the myocardial work efficiency [GWE (95 ± 4, 94 ± 3, and 89 ± 12%, P < 0.001)]. Even after adjustments for confounding factors, including EF, diastolic function parameters, LV hypertrophy, history of heart failure and atrial fibrillation, patients with minor ST-T changes had significantly smaller LV global constructive work in comparison to those without [GWI (2260 ± 33 vs. 2025 ± 76 mmHg%, P = 0.007) and GCW (2501 ± 45 vs. 2210 ± 105 mmHg%, P = 0.003)]. In conclusion, in hypertensive patients with preserved LVEF, minor ST-T changes on electrocardiograms were associated with reduced constructive work in the LV.
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Gonçalves MA, Pedro JM, Silva C, Magalhães P, Brito M. Prevalence of major and minor electrocardiographic abnormalities and their relationship with cardiovascular risk factors in Angolans. IJC HEART & VASCULATURE 2022; 39:100965. [PMID: 35198725 PMCID: PMC8842030 DOI: 10.1016/j.ijcha.2022.100965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/19/2022] [Accepted: 01/22/2022] [Indexed: 11/12/2022]
Abstract
Aims To identify the prevalence of major and minor electrocardiographic abnormalities and their association with the main risk factors for cardiovascular disease in a population in the province of Bengo, northern Angola. Methods A cross-sectional community-based study was conducted and a representative random sample stratified by sex and age was selected. In total, 2379 black individuals were included in the final analysis. A standard 12-lead ECG were recorded from all participants, analyzed and processed by the University of Glasgow software and coding by the Minnesota code. Results 22.3% of participants had minor electrocardiographic abnormalities and 4.58% major ECG abnormalities. The most common minor ECG abnormalities were abnormal T wave inversion, minor isolated ST abnormalities and premature beats. The most common major ECG abnormalities were Left ventricular hypertrophy with major ST-T abnormalities, Ventricular conduction defects and major Q-wave abnormalities. Hypertension, diabetes mellitus, hypercholesterolemia, alcohol consumption and smoking, were significantly associated with major and minor electrocardiographic abnormalities. Conclusions In this study several participants had minor and major electrocardiographic abnormalities. Minor electrocardiographic abnormalities were more prevalent in men and major abnormalities in women. The electrocardiographic abnormalities had significant associations with the main cardiovascular risk factors.
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Ren C, Li M, Ma T, Xu YB, Li Z, Xue HZ, Wang Q, Lu Y, Sun L, Zhang K. Nonspecific ST-Segment and T-Wave (NS-STT) on Electrocardiogram is Associated with Increasing the Incidence of Perioperative Deep Vein Thrombosis in Patients with Lower Extremity Fracture Under 75 Years Old. Int J Gen Med 2021; 14:8631-8641. [PMID: 34866930 PMCID: PMC8633707 DOI: 10.2147/ijgm.s335243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aims to explore the clinical correlation between nonspecific ST-segment or T-wave (NS-STT) changes and perioperative deep vein thrombosis (DVT) in patients with lower extremity fractures. Methods One thousand four hundred sixty-nine consecutive patients who suffered lower extremity fractures were screened at Xi’an Honghui Hospital between Feb 2016 and Nov 2018. According to the included and excluded criteria, the patients were included in this retrospective study. After collecting the electrocardiogram baseline, the patients were divided into the NS-STT group and the non-NS-STT group. After comparing the demographic and clinical characteristics, multivariate logistic regression models were used to identify the role of NS-STT changes on perioperative DVT. All analyses were performed with R and EmpowerStats software. Results Nine hundred and sixty-eight patients were included in the study. Ninety-seven patients (10.02%) had NS-STT changes on the electrocardiogram at admission. A total of 303 patients (31.30%) developed perioperative DVT in lower extremities. The univariate analysis showed that NS-STT segment changes were correlated with perioperative DVT significantly (OR = 3.45, 95% CI: 2.25–5.30, P < 0.0001). In addition, age ≥50 (P < 0.0001), female (OR = 1.50, 95% CI: 1.14–1.97, P = 0.0038), hypertension (OR = 1.54, 95% CI: 1.08–2.20, P = 0.0161), blood transfusion (OR = 1.78, 95% CI: 1.34–2.37, P < 0.0001), joint prosthesis (OR = 3.26, 95% CI: 2.21–4.81, P < 0.0001), and blood loss ≥300 mL (OR = 2.12, 95% CI: 1.50–3.01, P < 0.0001) were associated with perioperative DVT in lower extremities. We identified the confounding factors of age, gender, classification of internal implants, operation time, blood loss, and infusion. After adjustment for potential confounding factors, NS-STT changes were associated with perioperative DVT (OR = 2.13, 95% CI: 1.33–3.42; P = 0.0017). The sensitive analysis showed that the result was stable. Conclusion The NS-STT changes on electrocardiograms are associated with an increase in the incidence of perioperative DVT by 2.13-fold in patients with lower extremity fractures under 75 years old. In clinical practice, surgeons should pay more attention to these patients.
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Affiliation(s)
- Cheng Ren
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China
| | - Ming Li
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China
| | - Teng Ma
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China
| | - Yi-Bo Xu
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China
| | - Zhong Li
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China
| | - Han-Zhong Xue
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China
| | - Qian Wang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China
| | - Yao Lu
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China
| | - Liang Sun
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China
| | - Kun Zhang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China
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Hu Z, Wu L, Lin Z, Liu X, Zhao C, Wu Z. Prevalence and associated factors of Electrocardiogram abnormalities in patients with systemic lupus erythematosus: a machine learning study. Arthritis Care Res (Hoboken) 2021; 74:1640-1648. [PMID: 33787068 DOI: 10.1002/acr.24612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/02/2021] [Accepted: 03/25/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Electrocardiogram (ECG) abnormalities are predictive of subsequent cardiovascular events. Cardiac involvement is common in systemic lupus erythematosus (SLE). We aimed to determine the prevalence of ECG abnormalities in SLE patients and to examine the factors associated with ECG abnormalities with machine learning approaches. METHODS Consecutive SLE patients' records were retrieved from the database of the hospital for the cross-sectional study. Abnormal ECGs with clinical significance were grouped into tachyarrhythmias, atrioventricular block, non-specific ST-segment changes, T-wave abnormalities, ventricular hypertrophy, axis deviation, bundle branch block, and QT interval prolongation. Associated factors of the most common ECG abnormalities were assessed by comparing logistic regression and four other machine learning approaches. RESULTS Two hundred ninety-nine patients were enrolled. One hundred twenty-eight out of them were clinically significant abnormalities. T-wave changes (52.3%), non-specific ST-T changes (26.6%), and prolonged QT interval (8.6%) were the most prevalent abnormalities among patients with abnormal ECG. Random forest models had the best performance in the discovery of associated factors. Age, disease duration, ANA titer, disease activity (SLEDAI-2K) were associated with non-specific ST-T changes, prolonged QT interval, and T-wave changes. Hypertension, positive anti-SSA, and secondary Sjögren syndrome were influential factors for non-specific ST-T changes, prolonged QT interval, and T-wave changes specifically. CONCLUSION ST-T changes/T-wave changes were the most common abnormalities seen in ECGs of SLE patients. Our finding suggests that age, longer disease duration, higher disease activity, hypertension, anti-SSA antibody positive, and secondary Sjögren syndrome are important, influential factors for these ECG abnormalities.
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Affiliation(s)
- Zhuoran Hu
- Division of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, No.600, Tianhe Road, Guangzhou City, 51000, China
| | - Lin Wu
- Division of Cardiology, Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, No.600, Tianhe Road, Guangzhou City, 51000, China
| | - Zhiming Lin
- Division of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, No.600, Tianhe Road, Guangzhou City, 51000, China
| | - Xiuhua Liu
- Division of Rheumatology, Liuzhou Worker's Hospital (Fourth Affiliated Hospital of Guangxi Medical University, Yufeng District, ). No.1, Liushi Road, Liuzhou City, 545000, China
| | - Changlin Zhao
- Division of Cardiology, Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, No.600, Tianhe Road, Guangzhou City, 51000, China
| | - Zhen Wu
- Division of Cardiology, Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, No.600, Tianhe Road, Guangzhou City, 51000, China
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Sjöland H, Fu M, Caidahl K, Hansson PO. A negative T-wave in electrocardiogram at 50 years predicted lifetime mortality in a random population-based cohort. Clin Cardiol 2020; 43:1279-1285. [PMID: 32910465 PMCID: PMC7661687 DOI: 10.1002/clc.23440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 11/23/2022] Open
Abstract
Background Severe electrocardiographic (ECG) abnormalities in asymptomatic subjects correlate with cardiovascular risk. Hypothesis The role of minor ECG abnormalities is less well‐known. We evaluated the association between a negative T‐wave and mortality, as a possible marker for prognosis. Methods A prospective, population‐based cohort, examined at 50 years, and followed until death. Time to death (event rates) and predictive role of a negative T‐wave (Cox regression) were analyzed. Results Participants (n = 839) with a negative T‐wave (7.3%) had significantly higher blood pressure (BP) (mean systolic 157.9 mmHg vs 136.8 mmHg without negative T‐wave, P = <.0001). A negative T‐wave correlated with elevated risk (hazard ratio [HR] [95% CI] [confidence interval]) for all‐cause and cardiovascular (CV) death (1.59 (1.20‐2.11) P = .0012 vs 1.91 (1.34‐2.73) P = .0004). The association remained after excluding coexisting Q/QS patterns and ST‐junction/segment depression ECG abnormalities (1.66 [1.13‐2.44] P = .0098 for all‐cause vs 1.87 [1.13‐3.09] P = .015 for CV death). Death from other causes was not associated with a negative T‐wave. A major negative T‐wave carried higher risk than a minor (2.17 [1.25‐3.76] P = .0062 vs 1.78 [1.13‐2.79] P = .012) for CV death. Conclusion A negative T‐wave at 50 years, in asymptomatic individuals, carried an increased risk of all‐cause and CV death during lifetime follow‐up.
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Affiliation(s)
- Helen Sjöland
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kenneth Caidahl
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Cho MS, Nam GB, Kim YN, Kim J, Choi KJ, Kim YH. Clinical Implications of Ventricular Repolarization Parameters on Long-Term Risk of Atrial Fibrillation - Longitudinal Follow-up Data From a General Ambulatory Korean Population. Circ J 2020; 84:1067-1074. [PMID: 32461513 DOI: 10.1253/circj.cj-19-1151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study investigated 12-lead electrocardiogram (ECG) predictors associated with atrial fibrillation (AF) or flutter (AFL), specifically whether ventricular repolarization abnormalities in surface ECG (i.e., non-specific ST-T abnormalities [NSSTTA], QT prolongation, early repolarization [ER]) were associated with the development of AF or AFL.Methods and Results:This study included 16,793 ambulatory Koreans (mean age 48.2 years, 62.3% male) who underwent medical check-ups at Asan Medical Center in 2002 (NSSTTA, n=1,037 [6.2%]; ER, n=1,493 [8.9%]). The primary outcome was the incidence of ECG-documented AF or AFL. During follow-up, new-onset AF or AFL was documented in 334 subjects (2.0%). The incidence of AF or AFL at the 10-year follow-up was higher in patients with than without NSSTTA (3.5% vs. 1.6%; hazard ratio [HR] 1.79, 95% confidence interval [CI] 1.28-2.50). The QT interval was associated with a higher risk of AF or AFL (HR 1.12 [95% CI 1.07-1.17] per 10 ms), and the risk was even higher in patients with multiple-region NSSTTA (HR 2.30; 95% CI 1.64-3.21) and NSSTTA with QT prolongation (HR 4.06; 95% CI 2.14-7.69). ER was not associated with a higher risk of AF or AFL (HR 1.02; 95% CI 0.71-1.46). CONCLUSIONS NSSTTA and QT prolongation, but not ER, were associated with a higher risk of future AF or AFL in a general ambulatory population after adjusting for parameters of atrial depolarization.
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Affiliation(s)
- Min Soo Cho
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Gi-Byoung Nam
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Yu Na Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Jun Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Kee-Joon Choi
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - You-Ho Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
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Xiao L, Bai T, Zeng J, Yang R, Yang L. Nonalcoholic fatty liver disease, a potential risk factor of non-specific ST-T segment changes: data from a cross-sectional study. PeerJ 2020; 8:e9090. [PMID: 32440372 PMCID: PMC7229768 DOI: 10.7717/peerj.9090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/08/2020] [Indexed: 12/26/2022] Open
Abstract
Background Non-specific ST-T segment changes are prevalent and are proven risk factors for early onset of cardiovascular diseases. They can increase all-cause mortality by 100∼200% and are candidate for early signs of cardiovascular changes. Nonalcoholic fatty liver disease (NAFLD) is prevalent worldwide and is one facet of a multisystem disease that confers substantial increases morbidity and mortality of nonalcoholic fatty liver-related cardiovascular diseases. It is unclear whether NAFLD is associated with non-specific ST-T changes warning early signs of cardiovascular changes. Therefore, we investigated this association. Methods A cross-sectional study was designed that included a sample consisting of 32,922 participants who underwent health examinations. Participants with missing information, excessive alcohol intake, viral hepatitis, chronic liver disease or established cardiovascular diseases were excluded. Electrocardiograms were used for analysis of non-specific ST-T segment changes. NAFLD was diagnosed by ultrasonographic detection of hepatic steatosis without other liver diseases. A multivariable logistic regression model was served to calculate the OR and 95% CI for non-specific ST-T segment changes. Results The prevalence of non-specific ST-T segment changes was 6.5% in participants with NAFLD, however, the prevalence of NAFLD was 42.9% in participants with non-specific ST-T segment changes. NAFLD was independently associated with non-specific ST-T segment changes (OR: 1.925, 95% CI: 1.727-2.143, P < 0.001). After adjusting for age, sex, heart rate, hypertension, body mass index, fasting glucose, total cholesterol, triglycerides, HDL-C, NAFLD remained an independent risk factor of non-specific ST-T segment changes (OR: 1.289, 95% CI: 1.122-1.480). Conclusion Non-specific ST-T segment changes were independently associated with the presence of NAFLD after adjusting for potential confounders.
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Affiliation(s)
- Li Xiao
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Bai
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junchao Zeng
- Physical Examination (Health Management) Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Yang
- Physical Examination (Health Management) Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Yang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Istolahti T, Nieminen T, Huhtala H, Lyytikäinen LP, Kähönen M, Lehtimäki T, Eskola M, Anttila I, Jula A, Rissanen H, Nikus K, Hernesniemi J. Long-term prognostic significance of the ST level and ST slope in the 12‑lead ECG in the general population. J Electrocardiol 2020; 58:176-183. [PMID: 31911397 DOI: 10.1016/j.jelectrocard.2019.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/28/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Even minor ST depression in the electrocardiogram (ECG) is associated with cardiovascular disease and increased mortality. There is limited data on the prognostic significance of ST-level changes in the general population. SUBJECTS AND METHODS A random sample of Finnish subjects (n = 6354) aged over 30 years (56.1% women) underwent a health examination including a 12‑lead ECG in the Health 2000 survey. The effects of relative ST level as a continuous variable and ST slope (upsloping, horizontal, downsloping) in three different lead groups were analyzed using a multi-adjusted Cox proportional hazard model separately for men and women with total mortality as endpoint. RESULTS The follow-up lasted for 13.7 (SD 3.3) years for men and 13.9 (SD 3.1) years for women. Lower lateral ST levels were associated with all-cause mortality in multi-adjusted models in both genders (at J + 80 ms hazard ratio [HR] 0.64 for a change of 1.0 mm [95% confidence interval 0.49-0.84, p = 0.002] for men and HR 0.61 [0.48-0.78, p < 0.001] for women). Associated coronary heart disease had no major influence on the results. Exclusion of subjects with ECG signs of left ventricular hypertrophy from the analyses increased the mortality risk of lower lateral ST levels in men but decreased it in women. For the anterior and inferior lead groups, no statistically significant difference was seen after multivariate adjustment. ST slope was not an independent predictor of mortality after multivariate adjustment. CONCLUSION Lower ST level in the lateral ECG leads is an independent prognostic factor to predict all-cause mortality in the general population.
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Affiliation(s)
- Tiia Istolahti
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland; Department of Internal Medicine, Vaasa Central Hospital, Vaasa, Finland.
| | - Tuomo Nieminen
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Leo-Pekka Lyytikäinen
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland; Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Terho Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Markku Eskola
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Ismo Anttila
- Department of Emergency Services, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Antti Jula
- National Institute for Health and Welfare, Helsinki, Finland
| | - Harri Rissanen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Kjell Nikus
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
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12
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Hari KJ, Singleton MJ, Ahmad MI, Soliman EZ. Relation of Minor Electrocardiographic Abnormalities to Cardiovascular Mortality. Am J Cardiol 2019; 123:1443-1447. [PMID: 30792000 DOI: 10.1016/j.amjcard.2019.01.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/25/2019] [Accepted: 01/31/2019] [Indexed: 11/30/2022]
Abstract
Although minor electrocardiographic (ECG) abnormalities are common findings in clinical practice, their prognostic significance remains unclear due to inconsistent reports. We hypothesized that this inconsistency is due to the traditional focus on examining their prognostic significance as a binary variable (i.e., presence vs absence of any abnormality) ignoring the number of abnormalities. We tested this hypothesis in 6,467 participants (mean age 59 years, 53% women) from the Third National Health and Nutrition Examination Survey who were free of baseline cardiovascular disease (CVD) and major ECG abnormalities. ECG abnormalities were defined from digitally recorded and centrally processed standard electrocardiograms using the Minnesota ECG Classification. CVD mortality was ascertained using National Death Index. About 38% of participants (n = 2,438) had at least 1 minor ECG abnormality at baseline. During a median follow-up of 13.9 years, 755 CVD deaths occurred. In a multivariable Cox model, presence of at least 1 minor ECG abnormality was marginally associated with increased risk of CVD mortality (hazard ratio (95% confidence interval):1.15(1.00,1.34), p-value = 0.04)). However, as the number of ECG abnormalities increases, the association with CVD mortality showed a dose-response relation (event rate per 1,000 person-year of 7.3, 10.1, and 16.7 in participants with 0, 1, and ≥2 ECG abnormalities, respectively; p-value for trend <0.01). Also, each additional minor ECG abnormality was associated with a 13% increased risk of CVD mortality (hazard ratio (95% confidence interval): 1.13(1.04, 1.24)). In conclusion, the number, not only the mere presence of minor ECG abnormalities should be taken into account to understand the prognostic significance of these common findings.
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Affiliation(s)
- Krupal J Hari
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Matthew J Singleton
- Department of Internal Medicine, Cardiology Section, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Muhammad Imtiaz Ahmad
- Department of Internal Medicine, Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Elsayed Z Soliman
- Department of Internal Medicine, Cardiology Section, Wake Forest School of Medicine, Winston-Salem, North Carolina; Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.
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13
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Tamosiunas A, Petkeviciene J, Radisauskas R, Bernotiene G, Luksiene D, Kavaliauskas M, Milvidaitė I, Virviciute D. Trends in electrocardiographic abnormalities and risk of cardiovascular mortality in Lithuania, 1986-2015. BMC Cardiovasc Disord 2019; 19:30. [PMID: 30700252 PMCID: PMC6354422 DOI: 10.1186/s12872-019-1009-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 01/23/2019] [Indexed: 01/15/2023] Open
Abstract
Background This study aimed to assess the trends in the prevalence of electrocardiographic (ECG) abnormalities from 1986 to 2015 and impact of ECG abnormalities on risk of death from cardiovascular diseases (CVD) in the Lithuanian population aged 40–64 years. Methods Data from four surveys carried out in Kaunas city and five randomly selected municipalities of Lithuania were analysed. A resting ECG was recorded and CVD risk factors were measured in each survey. ECG abnormalities were evaluated using Minnesota Code (MC). Trends in age-standardized prevalence of ECG abnormalities were estimated for both sexes. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HR) for coronary heart disease (CHD) and CVD mortality. Net reclassification index (NRI), integrated discrimination improvement and other indices were used for evaluation of improvement in the prediction of CVD and CHD mortality risk after addition of ECG abnormalities variable to Cox models. Results From1986 to 2008, the decrease in the prevalence of Q-QS MC was observed in both genders. The prevalence of high R waves increased in men, while the prevalence of ST segment and T wave abnormalities as well as arrhythmias decreased in women. Ischemic changes and possible MI were associated with a 2.5-fold and 4.4-fold higher risk of death from CVD in men and 1.51-fold and 2.56-fold higher mortality risk from CVD in women as compared to individuals with marginal or no ECG abnormalities. The addition of ECG abnormalities to traditional CVD risk factors improved Cox regression models performance. According to NRI, 18.6% of men were correctly reclassified in CVD mortality prediction model and 25.2% of men - in CHD mortality prediction model. Conclusions the decreasing trends in the prevalence of ischemia on ECG in women and increasing trends in the prevalence of left VH in men were observed. ECG abnormalities were associated with higher risk of CVD mortality. The addition of ECG abnormalities to the prediction models modestly improved the prediction of CVD mortality beyond traditional CVD risk factors. The use of ECG as routine screening to identify high risk individuals for more intensive preventive interventions warrants further research.
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Affiliation(s)
- Abdonas Tamosiunas
- Institute of Cardiology, Academy of Medicine, Lithuanian University of Health Sciences, Sukileliu av. 15, LT-50162, Kaunas, Lithuania. .,Faculty of Public Health, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Janina Petkeviciene
- Faculty of Public Health, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ricardas Radisauskas
- Institute of Cardiology, Academy of Medicine, Lithuanian University of Health Sciences, Sukileliu av. 15, LT-50162, Kaunas, Lithuania.,Faculty of Public Health, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gailute Bernotiene
- Institute of Cardiology, Academy of Medicine, Lithuanian University of Health Sciences, Sukileliu av. 15, LT-50162, Kaunas, Lithuania
| | - Dalia Luksiene
- Institute of Cardiology, Academy of Medicine, Lithuanian University of Health Sciences, Sukileliu av. 15, LT-50162, Kaunas, Lithuania.,Faculty of Public Health, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mindaugas Kavaliauskas
- Faculty of Mathematics and Natural Sciences, Kaunas University of Technology, Kaunas, Lithuania
| | - Irena Milvidaitė
- Institute of Cardiology, Academy of Medicine, Lithuanian University of Health Sciences, Sukileliu av. 15, LT-50162, Kaunas, Lithuania
| | - Dalia Virviciute
- Institute of Cardiology, Academy of Medicine, Lithuanian University of Health Sciences, Sukileliu av. 15, LT-50162, Kaunas, Lithuania
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Bao H, Cai H, Zhao Y, Huang X, Fan F, Zhang C, Li J, Chen J, Hong K, Li P, Wu Y, Wu Q, Wang B, Xu X, Li Y, Huo Y, Cheng X. Nonspecific ST-T changes associated with unsatisfactory blood pressure control among adults with hypertension in China: Evidence from the CSPTT study. Medicine (Baltimore) 2017; 96:e6423. [PMID: 28353570 PMCID: PMC5380254 DOI: 10.1097/md.0000000000006423] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Nonspecific ST-segment and T-wave (ST-T) changes represent one of the most prevalent electrocardiographic abnormalities in hypertensive patients. However, a limited number of studies have investigated the association between nonspecific ST-T changes and unsatisfactory blood pressure (BP) control in adults with hypertension.The study population comprised 15,038 hypertensive patients, who were selected from 20,702 participants in the China Stroke Primary Prevention Trial. The subjects were examined with electrocardiogram test at the initial visit in order to monitor baseline heart activity. According to the results of the electrocardiogram (defined by Minnesota coding), the subjects were divided into 2 groups: ST-T abnormal and ST-T normal. Unsatisfactory BP control was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg following antihypertensive treatment during the 4.5-year follow-up period. Multivariate analysis was used to analyze the association between nonspecific ST-T abnormalities and unsatisfactory BP control.Nonspecific ST-T changes were common in hypertensive adults (approximately 8.5% in the study), and more prevalent in women (10.3%) and diabetic patients (13.9%). The unsatisfactory BP control rate was high in the total population (47.0%), notably in the ST-T abnormal group (55.5%). The nonspecific ST-T abnormal group exhibited a significantly greater rate of unsatisfactory BP control (odds ratio [OR] 1.20, 95% confidence interval [CI] [1.06, 1.36], P = 0.005]), independent of traditional risk factors, as demonstrated by multivariate regression analysis. Notable differences were further observed in male subjects (OR 1.51, 95% CI [1.17, 1.94], P = 0.002) and in patients with comorbid diabetes (OR 1.47, 95% CI [1.04, 2.07], P = 0.029).Greater rates of unsatisfactory BP control in hypertensive patients with electrocardiographic nonspecific ST-T abnormalities were observed, notably in the subcategories of the male subjects and the diabetic patients.
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Affiliation(s)
- Huihui Bao
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Huaxiu Cai
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Yan Zhao
- Department of Cardiovascular Medicine, XinHua Hospital Affiliated to Shanghai Jiao Tong, University School of Medicine, Shanghai
| | - Xiao Huang
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Fangfang Fan
- Department of Cardiology, Peking University First Hospital, Beijing
| | - Chunyan Zhang
- National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ, Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Juxiang Li
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Jing Chen
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Kui Hong
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Ping Li
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Yanqing Wu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Qinhua Wu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Binyan Wang
- National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ, Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiping Xu
- National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ, Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yigang Li
- Department of Cardiovascular Medicine, XinHua Hospital Affiliated to Shanghai Jiao Tong, University School of Medicine, Shanghai
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
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15
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Sawai T, Imano H, Muraki I, Hayama-Terada M, Shimizu Y, Cui R, Kitamura A, Kiyama M, Okada T, Ohira T, Yamagishi K, Umesawa M, Sankai T, Iso H. Changes in ischaemic ECG abnormalities and subsequent risk of cardiovascular disease. HEART ASIA 2017; 9:36-43. [PMID: 28176973 PMCID: PMC5278342 DOI: 10.1136/heartasia-2016-010846] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/13/2016] [Accepted: 12/16/2016] [Indexed: 11/24/2022]
Abstract
Objective The prognostic importance of changes in ischaemic ECG abnormalities over time (especially ST-T abnormalities) among Asians has not been fully investigated. We examined the associations between changes in ischaemic abnormalities upon serial ECG (improvement, persistence, deterioration) and cardiovascular disease (CVD) risk. Methods A prospective study cohort was conducted with 9374 men and women aged 40–69 years in four communities. Participants had multiple ECGs at study entry and during the next 10 years, and were followed up for a median period of 23.0 years. Total CVD (stroke and coronary heart disease) was ascertained under systematic surveillance. ECG abnormalities were defined by the Minnesota Code, ST depression (Code4), abnormal T wave (Code5) and categorised into nine groups (no–no, no–minor, no–major, minor–no, minor–minor, minor–major, major–no, major–minor, major–major) by comparison with the point of entrance and maximum change. Results We documented 1196 CVD events. Compared with no–no abnormality, no–minor, minor–major and major–major in Code4, HRs (95% CI) adjusted for cardiovascular risk factors were 1.19 (1.00–1.42), 1.57 (1.15–2.12) and 1.87 (1.42–2.47). Similar results were observed in Code5. Conclusions Changes in ischaemic ECG abnormalities from none to minor, and minor to major, as well as persistent major abnormalities, were associated with an increased risk of CVD.
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Affiliation(s)
- Takeshi Sawai
- Public Health, Department of Social Medicine , Osaka University Graduate School of Medicine , Osaka , Japan
| | - Hironori Imano
- Public Health, Department of Social Medicine , Osaka University Graduate School of Medicine , Osaka , Japan
| | - Isao Muraki
- Osaka Center for Cancer and Cardiovascular Disease Prevention , Osaka , Japan
| | - Mina Hayama-Terada
- Osaka Center for Cancer and Cardiovascular Disease Prevention , Osaka , Japan
| | - Yuji Shimizu
- Osaka Center for Cancer and Cardiovascular Disease Prevention , Osaka , Japan
| | - Renzhe Cui
- Public Health, Department of Social Medicine , Osaka University Graduate School of Medicine , Osaka , Japan
| | - Akihiko Kitamura
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan; Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Masahiko Kiyama
- Osaka Center for Cancer and Cardiovascular Disease Prevention , Osaka , Japan
| | - Takeo Okada
- Osaka Center for Cancer and Cardiovascular Disease Prevention , Osaka , Japan
| | - Tetsuya Ohira
- Department of Epidemiology , Fukushima Medical University School of Medicine , Fukushima , Japan
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan
| | - Mitsumasa Umesawa
- Department of Public Health, Dokkyo Medical University School of Medicine , Tochigi , Japan
| | - Tomoko Sankai
- Department of Community Health, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine , Osaka University Graduate School of Medicine , Osaka , Japan
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16
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Geraldino-Pardilla L, Gartshteyn Y, Piña P, Cerrone M, Giles JT, Zartoshti A, Bathon JM, Askanase AD. ECG non-specific ST-T and QTc abnormalities in patients with systemic lupus erythematosus compared with rheumatoid arthritis. Lupus Sci Med 2016; 3:e000168. [PMID: 28079193 PMCID: PMC5174789 DOI: 10.1136/lupus-2016-000168] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 10/29/2016] [Accepted: 09/03/2016] [Indexed: 12/29/2022]
Abstract
Objectives Cardiovascular disease (CVD) is a leading cause of death in systemic lupus erythematosus (SLE) and in rheumatoid arthritis (RA). Although only explored in one study, ECG non-specific ST-T abnormalities, in addition to corrected QT-interval (QTc) prolongation, were recently reported in an SLE inception cohort. Importantly, these ECG abnormalities are known predictors of CVD mortality in the general population, yet their prevalence in patients with established SLE has not been evaluated. Methods We cross-sectionally investigated the presence of non-specific ST-T and QTc abnormalities in 50 patients with SLE, predominantly Hispanic and black, without CVD or SLE-related cardiac involvement and compared them with 139 patients with RA without CVD. Demographics, disease-specific characteristics and CVD risk factors were ascertained and adjusted for. Results Patients with SLE (mean age 36±13 years, 92% women, 6 years median disease duration, 96% Hispanics and blacks) had a 3.3-fold higher adjusted prevalence of non-specific ST-T abnormalities (56% vs 17%; p <0.0001) compared with RA, despite the older age and higher percentage of men in the RA group. The QTc was 26 ms longer in SLE compared with RA (p=0.002) in the setting of a higher percentage of women, blacks, Hispanics and higher C reactive protein levels in the SLE group. Conclusions This study demonstrates a high prevalence of ECG abnormalities in predominantly Hispanic and black patients with SLE. Longitudinal evaluation of the progression to potentially life-threatening arrhythmias and/or cardiovascular events is warranted.
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Affiliation(s)
| | - Yevgeniya Gartshteyn
- Columbia University, College of Physicians & Surgeons , New York, New York , USA
| | - Paloma Piña
- Northwestern University , Chicago, Illinois , USA
| | - Marina Cerrone
- New York University (NYU) School of Medicine , New York, New York , USA
| | - Jon T Giles
- Columbia University, College of Physicians & Surgeons , New York, New York , USA
| | - Afshin Zartoshti
- Columbia University, College of Physicians & Surgeons , New York, New York , USA
| | - Joan M Bathon
- Columbia University, College of Physicians & Surgeons , New York, New York , USA
| | - Anca D Askanase
- Columbia University, College of Physicians & Surgeons , New York, New York , USA
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17
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Lohrmann GM, Peters F, Srivathsan K, Essop MR, Mookadam F. Electrocardiographic Abnormalities in Disease-Free Black South Africans and Correlations With Echocardiographic Indexes and Early Repolarization. Am J Cardiol 2016; 118:765-70. [PMID: 27381667 DOI: 10.1016/j.amjcard.2016.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 02/08/2023]
Abstract
Electrocardiographic abnormalities, and specifically early repolarization (ER) patterns, are increasingly found to be common variants in healthy populations free of heart disease or risk factors. Data are sparse in subjects of African descent, for which no increase in adverse cardiovascular outcomes have been demonstrated. A database of healthy disease-free adult volunteers of sub-Saharan African descent had 12 lead electrocardiograms (ECGs) and transthoracic echocardiograms performed. Statistical tests were then performed on the data to elicit associations; 396 volunteers (63.1% women) with a mean age of 37.4 years met the inclusion and exclusion criteria. An abnormal ECG was identified in 50.5% of volunteers, largely because of underlying ST elevation at the J point (ER), left ventricular hypertrophy (LVH) by voltage criteria, and T-wave inversion. Men were more likely to have abnormal ECGs (odds ratio [OR] 1.75; p <0.001), axes (OR 2.05; p = 0.023), display LVH by Sokolow-Lyon voltage criteria (OR 5.45; p <0.001), and have ER patterns (OR 11.61; p <0.001). Additionally, younger adults were also more likely to display LVH by voltage criteria and ER patterns. Volunteers with LVH by ECG had 5.7% higher LV mass indexes (p = 0.047). An abnormal ECG was not associated with a reduced left ventricular ejection fraction or diastolic dysfunction. ECG abnormalities, especially ER patterns, in black adults of Sub-Saharan descent are common, occurring in half of the normal adults.
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18
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Association of Traditional Cardiovascular Risk Factors With Development of Major and Minor Electrocardiographic Abnormalities. Cardiol Rev 2016; 24:163-9. [DOI: 10.1097/crd.0000000000000109] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Electrocardiographic Predictors of Cardiovascular Mortality. DISEASE MARKERS 2015; 2015:727401. [PMID: 26257460 PMCID: PMC4519551 DOI: 10.1155/2015/727401] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 06/20/2015] [Accepted: 07/02/2015] [Indexed: 01/26/2023]
Abstract
Cardiovascular diseases are the main causes of mortality. Sudden cardiac death may also appear in athletes, due to underlying congenital or inherited cardiac abnormalities. The electrocardiogram is used in clinical practice and clinical trials, as a valid, reliable, accessible, inexpensive method. The aim of the present paper was to review electrocardiographic (ECG) signs associated with cardiovascular mortality and the mechanisms underlying those associations, providing a brief description of the main studies in this area, and consider their implication for clinical practice in the general population and athletes. The main ECG parameters associated with cardiovascular mortality in the present paper are the P wave (duration, interatrial block, and deep terminal negativity of the P wave in V1), prolonged QT and Tpeak-Tend intervals, QRS duration and fragmentation, bundle branch block, ST segment depression and elevation, T waves (inverted, T wave axes), spatial angles between QRS and T vectors, premature ventricular contractions, and ECG hypertrophy criteria.
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20
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Abstract
OBJECTIVE To investigate the predictive value of T-wave inversion (TWI) on routine electrocardiogram (ECG) for mortality in the general population with various risk groups in a prospective population-based follow-up study. Subjects. ECGs of a random population-based sample of 1814 men aged 42-60 years without coronary heart disease (CHD) at baseline. RESULTS During an average follow-up of 21 years, 685 deaths occurred. Of these deaths 174 were due to CHD and 278 to cardiovascular disease (CVD). There were 57 subjects with TWI. After adjusting for age, TWI was associated with an increased CHD mortality (relative risk (RR) 4.10, 95% CI 2.26-7.41), CVD mortality (RR 3.47, 95% CI 2.09-5.78), and all-cause mortality (RR 2.07, 95% CI 1.37-3.12). After further adjustment for conventional risk factors, TWI remained statistically significant, predicting CHD mortality (RR 2.62, 95% CI 1.57-4.36), CVD mortality (RR 2.18, 95% CI 1.40-3.38), and all-cause mortality (RR 1.41, 95% CI 1.00-2.01), respectively. CONCLUSION TWI is a strong predictor for CHD, CVD, and all-cause mortality in the general population. The respective risks of CHD and CVD among men with TWI were also increased among men with high blood pressure, LDL cholesterol, and obesity.
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Affiliation(s)
- Sudhir Kurl
- Institute of Public Health and Clinical Nutrition, Department of Medicine, University of Eastern Finland , Kuopio , Finland
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21
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Laukkanen JA, Di Angelantonio E, Khan H, Kurl S, Ronkainen K, Rautaharju P. T-wave inversion, QRS duration, and QRS/T angle as electrocardiographic predictors of the risk for sudden cardiac death. Am J Cardiol 2014; 113:1178-83. [PMID: 24513474 DOI: 10.1016/j.amjcard.2013.12.026] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 11/26/2022]
Abstract
The aim of this study was to investigate the prognostic utility of isolated T-wave inversion (TWI), QRS duration, and QRS/T angle on electrocardiogram at rest as predictors for sudden cardiac death (SCD) and death from all causes. The assessment of electrocardiographic findings was based on a population-based cohort of 1,951 men (age 42 to 61 years) with a follow-up period of 20 years. Isolated TWI in the absence of ST depression, bundle branch block or major arrhythmias, prolonged QRS duration from 110 to 119 ms, and a wide QRS/T angle of >67° were identified from the 12-lead electrocardiograms. SCD was observed in 171 men (8.3%) during the follow-up. As a single electrocardiographic parameter, TWI (prevalence 2.4%) was associated with an increased risk of SCD (hazard ratio [HR] 3.30, 95% confidence interval [CI] 1.91 to 5.71, p<0.001) after adjustment for age and clinical factors. Similarly, prolonged QRS duration and wide QRS/T angle were significantly related to the risk of SCD, with HR 1.50 (95% CI 1.08 to 2.19, p=0.017) for QRS duration and HR 3.03 (95% CI 2.23 to 4.14, p<0.001) for QRS/T angle. The integrated discrimination improvement was significant when TWI (0.014, p=0.036) or QRS/T angle (0.015, p=0.002) was added to the model with age and clinical factors. In conclusion, TWI, QRS duration, and QRS/T angle are significantly associated with the risk of SCD and death from all causes beyond conventional cardiovascular risk predictors in the general population.
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Affiliation(s)
- Jari Antero Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Department of Internal Medicine, Lapland Central Hospital, Rovaniemi, Finland.
| | - Emanuele Di Angelantonio
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Hassan Khan
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Sudhir Kurl
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Department of Internal Medicine, Lapland Central Hospital, Rovaniemi, Finland
| | - Kimmo Ronkainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Pentti Rautaharju
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Li Y, Dawood FZ, Chen H, Jain A, Walsh JA, Alonso A, Lloyd-Jones DM, Soliman EZ. Minor isolated Q waves and cardiovascular events in the MESA study. Am J Med 2013; 126:450.e9-450.e16. [PMID: 23582938 PMCID: PMC3741651 DOI: 10.1016/j.amjmed.2012.10.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 10/31/2012] [Accepted: 10/31/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The significance of minor isolated Q waves in the resting electrocardiograms (ECGs) of apparently healthy individuals is unknown. OBJECTIVE To examine the association between minor isolated Q waves and incident cardiovascular disease events in the Multi-Ethnic Study of Atherosclerosis (MESA). DESIGN This analysis included 6551 MESA participants (38% white, 28% black, 22% Hispanic, 12% Chinese) who were free of cardiovascular disease at enrollment. Cox proportional hazards models were used to examine the association between minor isolated Q waves defined by the Minnesota ECG Classification with adjudicated incident cardiovascular events. RESULTS During up to 7.8 years of follow-up, 423 events occurred, with a rate of 10.7 events per 1000 person-years. A significant interaction between minor isolated Q waves and race/ethnicity was observed (P=.030). In models stratified by race/ethnicity and adjusted for demographics, socioeconomic status, common cardiovascular risk factors, and other ECG abnormalities, presence of isolated minor Q waves was significantly associated with incident cardiovascular events in Hispanics (hazard ratio [HR] 2.62; 95% confidence interval [CI], 1.42-4.82), but not in whites (HR 0.65; 95% CI, 0.32-1.33) or blacks (HR 1.46; 95% CI, 0.74-2.89). Despite the statistically significant association in the Chinese population, the small number of events precluded solid conclusions in this race/ethnicity. CONCLUSION The prognostic significance of minor isolated Q waves varies across races/ethnicities; they carry a high risk for future cardiovascular events in apparently healthy Hispanics, but not in whites or blacks.
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Affiliation(s)
- Yabing Li
- Epidemiological Cardiology Research Center (EPICARE), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
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23
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Walsh JA, Prineas R, Soliman EZ, Liu K, Ning H, Daviglus ML, Lloyd-Jones DM. Association of isolated minor non-specific ST-segment and T-wave abnormalities with subclinical atherosclerosis in a middle-aged, biracial population: Coronary Artery Risk Development in Young Adults (CARDIA) study. Eur J Prev Cardiol 2012; 20:1035-41. [PMID: 22952292 DOI: 10.1177/2047487312460017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Isolated minor non-specific ST-segment and T-wave abnormalities (NSSTTAs) are common and known to be independent electrocardiographic risk markers for future cardiovascular disease (CVD) events. The association of NSSTTA with subclinical atherosclerosis is not well defined, but has been postulated as a potential mechanism of association with future clinical events. METHODS AND RESULTS We studied participants from the Year 20 examination of the middle-aged, biracial CARDIA cohort. This examination included measurement of traditional risk factors, 12-lead electrocardiograms (ECGs), coronary artery calcium (CAC) measurement and common carotid intima-media thickness (CC-IMT). ECGs were coded using both Minnesota Code (MC) and Novacode (NC) criteria. Isolated minor STTA was defined by MC as presence of MC 4-3, 4-4, 5-3, or 5-4, and by NC as presence of NC 5.8. ECGs with secondary causes of STTA (i.e., LVH) were excluded. Multivariable logistic regression was used to determine the cross-sectional association of isolated minor NSSTTAs with CAC and CC-IMT. The study sample consisted of 2175 participants with an average age of 45 years (57% female and 43% Black). Isolated NSSTTAs were present in 5.1% of males and 6.3% of females. No association was observed between NSSTTA and CAC. After multivariable-adjustment for traditional CVD risk factors, the presence of isolated minor NSSTTAs remained significantly associated with the extent of CC-IMT (odds ratio 1.25 (1.06-1.48), p < 0.01). This association remained significant after further adjustment for CAC. CONCLUSIONS Isolated minor NSSTTAs were associated with the extent of CC-IMT, but not with CAC, in this middle-aged biracial cohort. Further study is needed to elucidate potential mechanisms for these findings.
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Affiliation(s)
- Joseph A Walsh
- Bluhm Cardiovascular Institute, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
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24
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Bakhoya VN, Kurl S, Laukkanen JA. T-wave inversion on electrocardiogram is related to the risk of acute coronary syndrome in the general population. Eur J Prev Cardiol 2012; 21:500-6. [PMID: 22952285 DOI: 10.1177/2047487312460022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND T-wave inversion (TWI) is a frequently encountered electrocardiographic (ECG) finding during routine medical examination of asymptomatic individuals, and of patients with various clinical conditions. However, the role of isolated TWI in the prediction of acute coronary syndrome (ACS) in the community has not been extensively studied. We investigated the relationship between TWI in routine ECG and the risk for ACS in the general population. METHODS This study is based on a random sample of 1997 men aged 42-60 years in Eastern Finland. Electrocardiograms recorded at rest were classified using the Minnesota codes. The association between isolated TWI and ACS was determined using a multivariable adjusted Cox proportional hazard model. RESULTS Negative T-waves were present in 3.6% of the participants. During an average follow-up of 20 years, a total of 493 ACS events were registered. After adjusting for age, TWI was associated with a 3.10-fold (95% confidence interval (CI) 2.21-4.32) risk for ACS. After additional adjustment for previously known coronary risk factors, TWI remained statistically significant in predicting ACS (relative risk 2.23; 95% CI 1.57-3.15). Negative T-waves was one of the strongest risk markers for ACS compared with other ECG-based variables such as left ventricular hypertrophy, previous Q-wave and prolonged QRS duration. CONCLUSION TWI has a strong and independent predictive value for ACS in the general population.
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Affiliation(s)
- Victor N Bakhoya
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Finland
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25
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Isolated nonspecific ST-segment and T-wave abnormalities in a cross-sectional United States population and Mortality (from NHANES III). Am J Cardiol 2012; 110:521-5. [PMID: 22608358 DOI: 10.1016/j.amjcard.2012.04.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 04/17/2012] [Accepted: 04/17/2012] [Indexed: 10/28/2022]
Abstract
Most clinicians regard isolated, minor, or nonspecific ST-segment and T-wave (NS-STT) abnormalities to be incidental, often transient, and benign findings in asymptomatic patients. We sought to evaluate whether isolated NS-STT abnormalities on routine electrocardiograms (ECGs) are associated with increased risk of cardiovascular mortality (CM) and all-cause mortality (AM) in a cross-sectional United States population without known coronary artery disease. We included all adults 40 to 90 years of age without known coronary artery disease or risk equivalent based on history and laboratory values, enrolled in the NHANES III from 1988 to 1994, with electrocardiographic data available, and a total follow-up period of 59,781.75 patient-years. NS-STT abnormalities were defined by Minnesota Coding. Subjects were excluded if their mortality data were missing or if they had major electrocardiographic abnormalities, heart rate >120 beats/min, nonsinus rhythm, cardiac infarction/injury score ≥ 20 on ECG, left ventricular hypertrophy by Minnesota Codes 3.1 and 3.3, or patient-reported history coronary artery disease, congestive heart failure, stroke, diabetes, or peripheral arterial disease. The remaining 4,426 subjects were stratified by presence or absence of NS-STT abnormalities. Mortality was judged based on International Classification of Diseases, Tenth Revision coding linked to the National Death Index. Cox proportional hazard ratio was used for multivariate analysis, showing that CM (hazards ratio 1.71, 95% confidence interval 1.04 to 2.83, p = 0.04) and AM (hazards ratio 1.37, 95% confidence interval 1.03 to 1.81, p = 0.02) were significantly higher in the isolated NS-STT abnormalities group. In conclusion, isolated NS-STT abnormalities on ECG were associated with a higher incidence of CM and AM in this large nationally representative cross-sectional cohort without known coronary artery disease or coronary artery disease risk equivalents.
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Low Vital Capacity and Electrocardiographic ST-T Abnormalities in Asymptomatic Adults. Pulm Med 2012; 2012:460398. [PMID: 22685652 PMCID: PMC3364692 DOI: 10.1155/2012/460398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 03/24/2012] [Indexed: 11/17/2022] Open
Abstract
Studies have shown that low forced vital capacity (LFVC) is associated with atherosclerosis. However, it is unclear whether LFVC is associated with resting electrocardiographic ST-T abnormalities, a common finding that is prognostic for cardiovascular events. Therefore, pulmonary functions, ST-T abnormalities defined with Minnesota Code, and cardiometabolic risk factors were examined in a cross-sectional study of 1,653 asymptomatic adults without past history of coronary heart diseases. The prevalence of diabetes, metabolic syndrome, and ST-T abnormalities significantly increased with decreasing percent of predicted forced vital capacity (%PFVC). ST-T abnormalities were observed in 73 subjects (4.4% in total). Multiple logistic regression analysis showed that, compared with the highest quartile of %PFVC (≥99.7%), the lowest quartile of %PFVC (≤84.2%) was persistently associated with ST-T abnormalities even after further adjustment for diabetes or metabolic syndrome (odds ratio (95%CI): 2.44 (1.16–5.14) and 2.42 (1.15–5.10), resp.). Similar trends were observed when subjects were divided into quartiles according to percent of predicted forced expiratory volume in 1 second (FEV1), but not the ratio of FEV1/FVC. In conclusion, LFVC may be associated with ST-T abnormalities independent of metabolic abnormalities in asymptomatic adults, suggesting a plausible link between impaired pulmonary defects and cardiovascular diseases.
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Scheltens T, de Beus MF, Hoes AW, Rutten FH, Numans ME, Mosterd A, Kors JA, Grobbee DE, Bots ML. The potential yield of ECG screening of hypertensive patients: the Utrecht Health Project. J Hypertens 2010; 28:1527-33. [PMID: 20574251 DOI: 10.1097/hjh.0b013e328339f95c] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Several guidelines for hypertension and cardiovascular risk management recommend an ECG in hypertensive patients to improve risk prediction. We estimated the prevalence of clinically relevant ECG abnormalities and the number needed to screen (NNS) with a routine ECG to prevent the occurrence of one death in the next 10 years conditional on adequate treatment and follow-up. METHODS The study population consisted of 866 hypertensive participants recruited from the Utrecht Health Project (UHP), a dynamic population study in Utrecht. Baseline measurements included an ECG and the risk factors that enable a Systematic COronary Risk Evaluation (SCORE) risk estimation for each participant. ECGs were interpreted using Modular ECG Analysis System for computerized recognition of ECG abnormalities. NNS to prevent one death was computed by the reciprocal of the prevalence of the ECG abnormalities multiplied by number needed to treat to prevent one death when the ECG abnormality is managed according to the prevailing clinical guidelines. RESULTS The population consisted of 54.2% men with a mean age of 53.2 years (SD 11.5). The prevalence of ECG abnormalities was 17.6 [n = 95% confidence interval (CI) 15.0-20.1]. Prevalence of atrial fibrillation or prior myocardial infarction was 2.1% (95%CI 1.1-3.0) and of other ECG abnormalities related to increased cardiovascular disease risk 15.4% (95%CI 13.1-17.9). NNS to prevent one death from cardiovascular disease within 10 years was estimated at 260 (95%CI 220-308). CONCLUSION Our findings support the existing recommendations to routinely record an ECG in unselected hypertensive patients as the prevalence of relevant abnormalities is considerable and NNS to prevent one death is lower than that in other widely accepted tests.
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Affiliation(s)
- Tjarda Scheltens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
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28
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Ackland GL, Harris S, Ziabari Y, Grocott M, Mythen M. Revised cardiac risk index and postoperative morbidity after elective orthopaedic surgery: a prospective cohort study. Br J Anaesth 2010; 105:744-52. [PMID: 20876700 DOI: 10.1093/bja/aeq245] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The revised cardiac risk index (RCRI) is associated strongly with increased cardiac ischaemic risk and perioperative death. Associations with non-cardiac morbidity in non-cardiac surgery have not been explored. In the elective orthopaedic surgical population, morbidity is common but preoperative predictors are unclear. We hypothesized that RCRI would identify individuals at increased risk of non-cardiac morbidity in this surgically homogenous population. METHODS Five hundred and sixty patients undergoing elective primary (>90%) and revision hip and knee procedures were studied. A modified RCRI (mRCRI) score was calculated, weighting intermediate and low risk factors. The primary endpoint was the development of morbidity, collected prospectively using the Postoperative Morbidity Survey, on postoperative day (POD) 5. RESULTS Morbidity on POD 5 was more frequent in patients with mRCRI ≥ 3 {relative risk 1.7, [95% confidence interval (CI): 1.4-2.1]; P<0.001}. Time to hospital discharge was delayed in patients with mRCRI score ≥ 3 (log-rank test, P=0.0002). Pulmonary (P<0.001), infectious (P=0.001), cardiovascular (P=0.0003), renal (P<0.0001), wound (P=0.02), and neurological (P=0.002) morbidities were more common in patients with mRCRI score ≥ 3. Pre/postoperative haematocrit, anaesthetic/analgesic technique, and postoperative temperature were similar across mRCRI groups. There were significant associations with hospital stay, as measured by the area under the receiver-operating characteristic curves for mRCRI 0.64 (95% CI: 0.58-0.70) and POSSUM 0.70 (95% CI: 0.63-0.75). CONCLUSIONS mRCRI score ≥ 3 is associated with increased postoperative non-cardiac morbidity and prolonged hospital stay after elective orthopaedic procedures. mRCRI can contribute to objective risk stratification of postoperative morbidity.
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Affiliation(s)
- G L Ackland
- Department of Medicine, Wolfson Institute for Biomedical Research, London, UK.
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Lloyd-Jones DM, Walsh JA, Prineas RJ, Ning H, Liu K, Daviglus ML, Shea S, Detrano RC, Tandri H, Greenland P. Association of electrocardiographic abnormalities with coronary artery calcium and carotid artery intima-media thickness in individuals without clinical coronary heart disease (from the Multi-Ethnic Study of Atherosclerosis [MESA]). Am J Cardiol 2009; 104:1086-91. [PMID: 19801030 DOI: 10.1016/j.amjcard.2009.05.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Revised: 05/22/2009] [Accepted: 05/22/2009] [Indexed: 01/09/2023]
Abstract
Isolated minor nonspecific ST-segment and T-wave abnormalities (NSSTAs), minor and major electrocardiographic (ECG) abnormalities are established, independent risk markers for incident cardiovascular events. Their association with subclinical atherosclerosis has been postulated but is not clearly defined. The aim of this study was to define the association between ECG abnormalities and measurements of subclinical atherosclerosis. We studied participants from MESA, a multiethnic sample of men and women 45 to 84 years of age and free of clinical cardiovascular disease at enrollment. Baseline examination included measurement of traditional risk factors, 12-lead electrocardiograms at rest, coronary artery calcium (CAC) measurement, and common carotid intima-media thickness (CC-IMT). Electrocardiograms were coded using Novacode criteria and were defined as having minor abnormalities (e.g., minor NSSTTAs, first-degree atrioventricular block, and QRS-axis deviations) or major abnormalities (e.g., pathologic Q waves, major STTAs, significant dysrhythmias, and conduction system delays). Multivariable logistic and linear regressions were used to determine cross-sectional associations of ECG abnormalities with CAC and CC-IMT. Of 6,710 participants, 52.7% were women, with a mean age of 62 years. After multivariable adjustment, isolated minor STTAs and minor and major ECG abnormalities were not associated with presence of CAC (>0) in men (odds ratio 1.04, 95% confidence interval 0.81 to 1.33; 1.10, 0.91 to 1.32; and 1.03, 0.81 to 1.31, respectively) or women (1.01, 0.82 to 1.24; 1.04, 0.87 to 1.23; and 0.94, 0.73 to 1.22, respectively). Lack of association remained consistent when using log CAC and CC-IMT as continuous variables. In conclusion, ECG abnormalities are not associated with markers of subclinical atherosclerosis in a large multiethnic cohort.
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Jorens PG, Robert D, van Thielen G, van Brabant J. Impressive but classical electrocardiograph changes after organophosphate poisoning. Clin Toxicol (Phila) 2009; 46:758-9. [PMID: 19238735 DOI: 10.1080/15563650701558586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Philippe G Jorens
- University Hospital of Antwerp, Critical Care Medicine, Edegem, Belgium.
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Kumar A, Prineas RJ, Arnold AM, Psaty BM, Furberg CD, Robbins J, Lloyd-Jones DM. Prevalence, prognosis, and implications of isolated minor nonspecific ST-segment and T-wave abnormalities in older adults: Cardiovascular Health Study. Circulation 2008; 118:2790-6. [PMID: 19064684 DOI: 10.1161/circulationaha.108.772541] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prevalence and prognostic significance of isolated minor nonspecific ST-segment and T-wave abnormalities (NSSTTAs) in older adults are poorly understood. METHODS AND RESULTS Cardiovascular Health Study participants free of both clinical cardiovascular disease and major ECG abnormalities were included. We examined the prospective association of isolated minor NSSTTAs (defined by Minnesota Codes 4-3, 4-4, 5-3, and 5-4) with total, cardiovascular, and coronary mortality and incident nonfatal myocardial infarction. Among 3224 participants (61.9% women; mean age, 72 years), 233 (7.2%) had isolated NSSTTAs at baseline. Covariates associated with isolated NSSTTAs included older age, nonwhite race (20.5% of blacks versus 4.8% of whites; P<0.001), diabetes, and higher blood pressure and body mass index but not the presence of subclinical cardiovascular disease. After 39 518 person-years of follow-up, the presence of isolated NSSTTAs was associated with significantly increased risk for coronary heart disease mortality (multivariable-adjusted hazards ratio, 1.76; 95% CI, 1.18 to 2.61) but not with incident nonfatal myocardial infarction (multivariable-adjusted hazards ratio, 0.71; 95% CI, 0.43 to 1.17). The association of isolated NSSTTAs with coronary death was independent of subclinical atherosclerosis and left ventricular mass measures. In secondary analyses, among those with cardiac death, there was a significantly higher rate of primary arrhythmic death (32.3% versus 15.4%; P=0.02) in participants with isolated NSSTTAs versus those without NSSTTAs. CONCLUSIONS Isolated NSSTTAs are common in older Americans and are associated with significantly increased risk for coronary death. However, isolated NSSTTAs are not associated with incident nonfatal myocardial infarction, suggesting that they are associated particularly with increased risk for primary arrhythmic death.
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Affiliation(s)
- Anita Kumar
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr, Suite 1102, Chicago, IL 60611, USA
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