Early repolarization pattern in an ethnically diverse population: Increased risk in Hispanics

Abstract

Background: Early repolarization (ER) pattern on ECG is associated with an increased mortality inCaucasians. This study analyzed the association between ER pattern and all-cause mortality in a population of multiple ethnicities. Methods:A total of 20 000 individuals were randomly selected and their ECGs were analyzed for ER pattern using the 2015 consensus: end-QRS notching or slurring with a J-point (Jp) ≥0.1 mV in contiguous inferior or lateral leads. Exclusion criteria were age <18, QRS duration of ≥120 ms, and acute myocardial infarction. Kaplan-Meier survival curves were used to assess crude survival, and multivariable logistic regression models were used to determine predictors of all-cause mortality.Results: A total of 17 901 patients with a mean age of 53 met inclusion criteria. Individuals were 62% female, 14% White, 37% Black, 40% Hispanic, and 9% other. Median follow-up time was 6.4 years. ER pattern was noted in 995 (5.6%) patients. Jp ≥2 mm was noted in 282 (1.6%) patients.In those with ER pattern and Jp ≥1 mm, there was no difference in mortality when compared to individuals without Jp elevation (odds ratio [OR]: 0.962, 95% confidence of interval [CI]: 0.819-1.131). Patients with Jp ≥2 mm had a significantly increased all-cause mortality (OR: 1.333, 95% CI: 1.009-1.742). This increased mortality was also significant in Hispanic patients with Jp ≥2 mm (OR: 1.584, 95% CI: 1.003-2.502).Conclusion: ER pattern with Jp ≥2 mm is associated with increased mortality in a multiethnic population, apparently driven by an increased risk in Hispanics.

Mortality risk of early repolarization pattern

“…The study agrees with prior studies in African‐American population that did not show higher overall cardiac mortality . In this study, Leiderman et al are the first to report significance in mortality in the Hispanic population, especially in those with Jp ≥0.2 mV with horizontal/downsloping ST morphologies, and in inferior leads (type 2 ER) compared to lateral leads (type 1 ER). These parameters have been previously studied and have been associated with higher risk of mortality.…”

“…The study agrees with prior studies in African-American population that did not show higher overall cardiac mortality. 17 In this study, Leiderman et al 19…”

Worldwide prevalence of early repolarization pattern in general population and physically active individuals

“…[ 33 ] Six studies reported the prevalence in the Asia, including 3 in China [ 32 , 35 , 44 ] and 1 each in Japan, [ 8 ] Korea, [ 15 ] and Thailand. [ 34 ] Eight studies reported the prevalence in the United States [ 16 , 20 , 25 , 28 , 37 , 40 , 42 , 45 ] and 1 each study reported the prevalence in Madagascar, [ 27 ] Egypt, [ 29 ] and Latin America. [ 26 ] The worldwide prevalence map of ERP by region was shown in Fig.…”

“…The characteristics of the 29 included studies involving a total general population of 182,135 subjects are shown in Table 1. Of the 29 studies, [5,8,15,16,19–21,24–45] 14 studies (48.3%) reported the prevalence in the Europe, including 3 in France, [5,30,38] 3 in Germany, [19,31,43] 3 in Finland, [21,24,40] 2 in the UK, [36,41] 2 in Italy, [27,39] and 1 in Spain [33] . Six studies reported the prevalence in the Asia, including 3 in China [32,35,44] and 1 each in Japan, [8] Korea, [15] and Thailand [34] .…”

“…Twenty-four studies [15,16,19–21,24–27,30–34,36–45] have discussed sex differences in the incidence of ERP. Additionally, the main characteristics of the 14 articles [22,46–58] included physically active individuals were summarized in Table 2.…”