Racial Differences in Electrocardiographic Characteristics and Prognostic Significance in Whites Versus Asians

Santhanakrishnan, Rajalakshmi; Wang, Na; Larson, Martin G.; Magnani, Jared; Vasan, Ramachandran S.; Wang, Thomas J.; Yap, Jonathan; Feng, Lixia; Yap, Keng Bee; Ong, Hean Yee; Ng, Tze Pin; Richards, A. Mark; Lam, Carolyn S.P.; Ho, Jennifer E.

doi:10.1161/jaha.115.002956

Cited by 30 publications

(19 citation statements)

References 36 publications

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“…Using data from the Third National Health and Nutrition Examination Survey linked to the National Death Index, Havranek et al found that ECG LVH contributed more to the risk of cardiovascular mortality in blacks than it did in whites. In an analysis of the Framingham Heart Study and the Singapore Longitudinal Aging Study, the presence of LVH had a greater effect on all‐cause mortality in Asians compared with whites . Taken together, these results and ours should raise awareness that different measures of ECG LVH could have different meanings in different subgroups of patients.…”

Section: Discussionsupporting

confidence: 54%

“…In an analysis of the Framingham Heart Study and the Singapore Longitudinal Aging Study, the presence of LVH had a greater effect on all-cause mortality in Asians compared with whites. 38 Taken together, these results and ours should raise awareness that different measures of ECG LVH could have different meanings in different subgroups of patients. Potential physiological explanations include the pattern of hypertrophy (blacks tend to develop a concentric pattern, which is linked to poorer prognosis) 39,40 and/or pleiotropic genetic predisposition to LVH and atherosclerotic CVD and stroke.…”

Section: Discussionsupporting

confidence: 51%

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Cohort Study of ECG Left Ventricular Hypertrophy Trajectories: Ethnic Disparities, Associations With Cardiovascular Outcomes, and Clinical Utility

Iribarren

Round

Lü

et al. 2017

JAHA

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BackgroundECG left ventricular hypertrophy (LVH) is a well‐known predictor of cardiovascular disease. However, no prior study has characterized patterns of presence/absence of ECG LVH (“ECG LVH trajectories”) across the adult lifespan in both sexes and across ethnicities. We examined: (1) correlates of ECG LVH trajectories; (2) the association of ECG LVH trajectories with incident coronary heart disease, transient ischemic attack, ischemic stroke, hemorrhagic stroke, and heart failure; and (3) reclassification of cardiovascular disease risk using ECG LVH trajectories.Methods and ResultsWe performed a cohort study among 75 412 men and 107 954 women in the Northern California Kaiser Permanente Medical Care Program who had available longitudinal exposures of ECG LVH and covariates, followed for a median of 4.8 (range <1–9.3) years. ECG LVH was measured by Cornell voltage‐duration product. Adverse trajectories of ECG LVH (persistent, new development, or variable pattern) were more common among blacks and Native American men and were independently related to incident cardiovascular disease with hazard ratios ranging from 1.2 for ECG LVH variable pattern and transient ischemic attack in women to 2.8 for persistent ECG LVH and heart failure in men. ECG LVH trajectories reclassified 4% and 7% of men and women with intermediate coronary heart disease risk, respectively.Conclusions ECG LVH trajectories were significant indicators of coronary heart disease, stroke, and heart failure risk, independently of level and change in cardiovascular disease risk factors, and may have clinical utility.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionsupporting

confidence: 51%

Cohort Study of ECG Left Ventricular Hypertrophy Trajectories: Ethnic Disparities, Associations With Cardiovascular Outcomes, and Clinical Utility

Iribarren

Round

Lü

et al. 2017

JAHA

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“…The present data can be used as the standard for pediatric ECG findings, although differences in race might have been present, as reported in adults. 19 …”

Section: Discussionmentioning

confidence: 99%

“…In adults, a sex difference in the PQ interval has been reported, with a difference in mean value between sexes of 10 ms in Whites and 6 ms in Asians. 19 ECG studies in the Netherlands showed an approximately 5-ms sex difference in the mean PQ interval, 7 suggesting that racial differences are also present in childhood.…”

Section: P Wavementioning

confidence: 99%

Standard Values and Characteristics of Electrocardiographic Findings in Children and Adolescents

Yoshinaga

Iwamoto²,

Horigome

et al. 2018

Circ J

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Background:Reference values and the characteristics of the electrocardiographic (ECG) findings using a large number of subjects are lacking for children and adolescents. Methods and Results:A total of 56,753 digitally stored ECGs of participants in a school-based ECG screening system were obtained between 2006 and 2009 in Kagoshima, Japan. Each ECG was manually reviewed by 2 pediatric cardiologists and only ECGs with sinus rhythm were included. A final total of 48,401 ECGs from 16,773 1st (6 years old, 50% girls), 18,126 7th (12 years old, 51% girls), and 13,502 10th graders (15 years old, 52% girls) were selected. ECG variables showed differences in age and sex. However, the effects of age and sex on ECG variables such as the PQ interval, QRS voltage, and STJ segment were also different. The 98th percentile values of well-known surrogate parameters for ventricular hypertrophy in the present study were much higher than the conventional criteria. Conclusions:The present study of a large number of pediatric subjects showed that the effects of age and sex on ECG parameters are different, and that criteria for ventricular hypertrophy should be newly determined by age and sex. We have developed reference data for STJ segment elevation for children and adolescents. These findings are useful for creating guidelines and recommendations for interpretation of pediatric ECG.

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“…4) A cohort study performed in Singapore also suggested that Asian populations might have different ECG-LVH cutoff levels for detecting anatomical LVH, 7) and the ECG-LVH was associated with an increased risk of cardiovascular events. 8) In the present study, we evaluated whether gender adjustment of the Cornell product was appropriate in hypertensive Japanese patients, and also determined the level of ECG-LVH corresponding to anatomical (echocardiographic) LVH.…”

Section: S Ubjects With Left Ventricular Hypertrophy (Lvh)mentioning

confidence: 99%

Gender-Adjustment and Cutoff Values of Cornell Product in Hypertensive Japanese Patients

et al. 2017

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SummaryIn the Japanese population, the electrocardiographic (ECG) Cornell voltage and product predict cardiovascular events at lower values (Cornell voltage of 2.04 mV in males and 1.71 mV in females, and Cornell product of 158.7 mV × msec) than in the guidelines (2.8 mV, 2.0 mV, and 244 mV × msec, respectively). We evaluated the ECG criteria for left ventricular hypertrophy (LVH) corresponding to echocardiographic LVH (Echo-LVH) in Japanese patients.We reviewed data on 345 consecutive hypertensive patients who underwent echocardiography, and evaluated the Cornell voltage (S in leads V3 + R in leads aVL), Cornell product [(Cornell voltage + 0.6 mV for females) × QRS duration], and left ventricular mass index (LVMI) (Echo-LVH: LVMI !116 g/m 2 in males and ! 96 g/m 2 in females). The mean age was 63.8 ± 12.5 years (174 males/172 females). Echo-LVH was found in 22.7% of males and 37.2% of females. The equations for estimating LVMI from the Cornell voltage were (1) LVMI = 14.5 × Cornell voltage + 78.9 for males and (2) LVMI = 21.5 × Cornell voltage + 61.5 for females. The Cornell voltage corresponding to Echo-LVH was 2.6 mV in males and 1.6 mV in females, which were below the guideline levels and close to the values indicating cardiovascular risk. The equation for estimating LVMI from the Cornell product was LVMI = 0.15 × Cornell product + 68.8. The Cornell product corresponding to Echo-LVH was 170 mV × msec (sensitivity: 0.730, specificity: 0.601), which was also close to the cardiovascular risk level.Cornell voltage and product values indicating Echo-LVH are lower than those in the current guidelines and closer to the cardiovascular risk levels. (Int Heart J 2017; 58: 933-938)

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Racial Differences in Electrocardiographic Characteristics and Prognostic Significance in Whites Versus Asians

Abstract: Background--Racial differences in electrocardiographic (ECG) characteristics and prognostic significance among Whites and Asians are not well described.

Cited by 30 publications

References 36 publications

Cohort Study of ECG Left Ventricular Hypertrophy Trajectories: Ethnic Disparities, Associations With Cardiovascular Outcomes, and Clinical Utility

Cohort Study of ECG Left Ventricular Hypertrophy Trajectories: Ethnic Disparities, Associations With Cardiovascular Outcomes, and Clinical Utility

Standard Values and Characteristics of Electrocardiographic Findings in Children and Adolescents

Gender-Adjustment and Cutoff Values of Cornell Product in Hypertensive Japanese Patients

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