Changes in ischaemic ECG abnormalities and subsequent risk of cardiovascular disease

Longitudinal association of premature atrial contractions with atrial fibrillation and brain ischemia in people with type 2 diabetes: The Hoorn Diabetes Care System cohort

Background

Premature atrial contractions (PACs) are potential markers for imminent onset of both atrial fibrillation (AF) and brain ischemia (BI; transient ischemic attack [TIA] or ischemic stroke). We investigated the association of PACs with incident AF and BI events separately, and of incident AF with BI events in people with type 2 diabetes (T2D) without pre-existing AF or cerebrovascular disease.

Methods

A prospective longitudinal study of 12,242 people with T2D without known AF or cerebrovascular disease from the Hoorn Diabetes Care System cohort. Annual measurements (1998-2018) included cardiovascular risk factors, over 85,000 ECGs, and self-reported cardiovascular events. We assessed the association of PACs with incident AF and BI events and of incident AF with BI events using time-dependent Cox-regression models, adjusted for time-varying cardiovascular risk factors and medication use (Hazard Ratios with 95%CIs).

Results

The baseline mean age was 62.2 ± 11.9 years. During a median follow-up of 7.0 (IQR 3.4-11.0) years, 1031 (8.4 %) participants had PACs, and 566 (4.6 %) had incident AF at any of the median 6 (IQR 3-10) annual ECG recordings. BI events occurred in 517 (4.2 %) people (304 TIAs, 213 ischemic strokes). After adjustment, PACs were associated with incident AF (Hazard Ratio, 1.96 (95%CI, 1.53-2.50)), but not with overall BI events (1.09 (0.76-1.56)), or with TIA (0.91 (0.57-1.46)) or ischemic stroke (1.50 (0.88-2.54)) separately. AF was not associated with BI events (0.95 (0.55-1.63)).

Conclusions

In people with T2D without a history of AF or BI events, PACs are associated with a two-fold increased risk of incident AF.

Longitudinal association of ECG abnormalities with major adverse cardiac events in people with type 2 diabetes: The Hoorn Diabetes Care System cohort

AIMS

To investigate the association of (changes in) ECG abnormalities with incident major adverse cardiac events (MACE) in people with type 2 diabetes (T2D) without pre-existing cardiovascular disease (CVD).

METHODS

A prospective longitudinal study of 11,993 people with T2D without known CVD from the Hoorn Diabetes Care System cohort. Annually repeated measurements (1998-2018), included cardiovascular risk factors, over 70,000 ECGs, and self-reported cardiovascular events. ECG abnormalities were classified according to the Minnesota Classification as prolonged PR duration, prolonged QRS duration, left QRS-axis, QS pattern, ST-segment/T-wave abnormalities, or tall R-wave. The association of ECG abnormalities with MACEs was assessed using time-dependent Cox-regression models, adjusted for time-varying cardiovascular risk factors and medication use (Hazzard Ratios with 95%CIs).

RESULTS

During a median follow-up of 6.6 (IQR, 3.1-10.7) years, 5445 (45.4%) of the participants had an ECG abnormality (prevalent or incident) at any of the median 6 (IQR, 3-10) annual ECG recordings, and 905 people (7.5%) had a MACE (529 CHD, 250 HF, 126 SCA). After adjustment, most ECG abnormalities were associated with HF: prolonged QRS duration (HR, 4.01 (95%CI, 2.67-6.03)), QS pattern (2.68 (0.85-8.49)), ST-segment/T-wave abnormalities (4.26 (2.67-6.80)), and tall R-wave (2.23 (1.33-3.76)). Only QS pattern (2.69 (1.20-6.03)), and ST-segment/T-wave abnormalities (2.11 (1.48-3.02)) were associated with CHD. These associations were robust across age, sex, hypertension, or estimated CVD risk subgroups.

CONCLUSION

In people with T2D without pre-existing cardiovascular disease, ECG abnormalities related to decelerated conduction, ischemia and hypertrophy are predominantly early signs of emerging HF, while only abnormalities related to ischemic disorders are signs of CHD.

Nonspecific ventricular repolarization abnormalities: A wolf in sheep's clothing

The term nonspecific ventricular repolarization abnormalities refers to a set of minor alterations of the ST segment and/or the T wave. For a long time, they have been of little clinical interest as they do not translate into specific diagnoses. It has even been asserted that they constitute benign electrocardiographic findings. Their presence has been reported in various cardiovascular and non-cardiovascular diseases. However, it is frequently identified in apparently healthy asymptomatic people. A growing number of studies demonstrate their importance as predictors of cardiovascular morbidity and mortality, expanding their spectrum towards cardiovascular prevention. In light of the body of scientific evidence, it is imperative that the traditional view of nonspecific ventricular repolarization abnormalities changes.

Assessment of diagnostic accuracy of SanketLife - A wireless, pocket-sized ECG biosensor, in comparison to standard 12 lead ECG in the detection of cardiovascular diseases in a tertiary care setting

Background

The SanketLife is a low cost, portable, pocket sized 12 lead ECG mechanised by SanketLife app running on compatible iOS and Android phones that connect wirelessly via Bluetooth technology to the device.

Objective

The current study was conducted to assess the diagnostic accuracy of SanketLife ECG in comparison to standard 12 lead ECG (GE-2000) in detection of cardiovascular diseases.

Research design and methods

This was a prospective diagnostic test accuracy trial conducted in outpatient settings of a tertiary cardiac care centre in India. A total of 100 patients, attended cardiology OPD, were included in the study. Consecutive ECGs were taken by 12 lead standard ECG as well as by SanketLife ECG. Diagnostic accuracy variables such as sensitivity, specificity, negative and positive predictive value, negative and positive likelihood ratios were estimated. Ethical permission was taken from the Institutional ethical committee.

Results & conclusion

The analysis showed a high degree of agreement and accuracy of SanketLife in detecting major cardiovascular conditions (Major Minnesota codes) such as Left and right bundle branch block, ST-segment elevation and ST-segment depression, AV conduction block. SanketLife showed high sensitivity (98.15%) and specificity (100%) in diagnosing major cardiovascular conditions.

Trends in electrocardiographic abnormalities and risk of cardiovascular mortality in Lithuania, 1986-2015

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.

The Circulatory Risk in Communities Study (CIRCS): A Long-Term Epidemiological Study for Lifestyle-Related Disease Among Japanese Men and Women Living in Communities

The Circulatory Risk in Communities Study (CIRCS) is an ongoing community-based epidemiological study of lifestyle-related disease involving dynamic prospective cohorts of approximately 12,000 adults from five communities of Japan: Ikawa, Ishizawa and Kita-Utetsu (Akita Prefecture), Minami-Takayasu (Osaka Prefecture), Noichi (Kochi Prefecture), and Kyowa (Ibaraki Prefecture). One of the most notable features of CIRCS is that it is not only an observational cohort study to identify risk factors for cardiovascular diseases (CVD), such as stroke, coronary heart disease, and sudden cardiac death, but it also involves prevention programs for CVD. Using basic, clinical, epidemiological, and statistical techniques, CIRCS has clarified characteristics of CVD and the related risk factors to develop specific methodologies towards CVD prevention in Japanese middle-aged or older adults for more than half a century.

Minor Electrocardiographic ST-T Change and Risk of Stroke in the General Japanese Population

BACKGROUND

Minor ST-T changes are frequently observed on the electrocardiogram (ECG), but the risk of stroke associated with such changes is unclear.Methods and Results:In 10,642 subjects from the Japanese general population, we evaluated minor and major ST-T changes (major ST depression ≥0.1 mV) on ECGs obtained at annual health examinations. At baseline, minor ST-T changes were found in 10.7% of the subjects and 0.5% had major ST-T changes. Minor ST-T changes were associated with older age, female gender, higher systolic blood pressure, presence of hyperlipidemia, and use of antihypertensive medication. There were 375 stroke events during the follow-up period (128.7±28.1 months). In all subjects, minor ST-T changes (HR, 2.10; 95% CI: 1.57-2.81) and major ST-T changes (HR, 8.64; 95% CI: 4.44-16.82) were associated with an increased risk of stroke, but the stroke risk associated with minor ST-T changes had borderline significance after adjustment for conventional risk factors (P=0.055). In subgroup analysis, the risk of stroke was significantly associated with minor ST-T changes in subjects who had hyperlipidemia (HR, 1.75; 95% CI: 1.15-2.67) compared to those without hyperlipidemia (HR, 1.01; 95% CI: 0.64-1.59; P for interaction=0.016), even after adjustment for ECG-diagnosed left ventricular hypertrophy.

CONCLUSIONS

Minor ST-T changes were particularly associated with a higher risk of stroke in subjects with hyperlipidemia and this association was independent of electrocardiographic left ventricular hypertrophy.