Electrocardiographic Predictors of Incident Congestive Heart Failure and All-Cause Mortality in Postmenopausal Women

Rautaharju, Pentti M.; Kooperberg, Charles; Larson, Joseph C.; LaCroix, Andrea Z.

doi:10.1161/circulationaha.105.537415

Cited by 124 publications

(99 citation statements)

References 40 publications

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“…This index is not sensitive to subjective definition of the end of the T-wave and is therefore a reproducible and reliable index of cardiac repolarisation. This index was recently described to be a powerful predictor of mortality in various populations [12][13][14][15][16]. TCRT values tended to be more abnormal (smaller) in diabetic patients, even when glucose levels were normal and the abnormality became more marked during hypoglycaemia, suggesting that hypoglycaemia further increases the heterogeneity in global repolarisation.…”

Section: Discussionmentioning

confidence: 97%

“…Therefore, novel repolarisation analyses have been developed to evaluate the characteristics of cardiac repolarisation with greater accuracy. New descriptors of T-wave morphology and the spatial QRS-T angle have already been shown to have better prognostic values than QT interval or QT dispersion with regard to cardiac events in several populations [12][13][14][15][16] and increased complexity of ventricular repolarisation measured by principal component analysis of T-wave morphology has been found to distinguish patients with congenital long QT syndrome from unaffected participants [17,18]. Therefore, we decided to study the effects of controlled insulininduced hypoglycaemia on the T-wave loop and the QRS complex loop in type 1 diabetic patients and age-matched non-diabetic control participants.…”

Section: Introductionmentioning

confidence: 99%

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Effects of controlled hypoglycaemia on cardiac repolarisation in patients with type 1 diabetes

et al. 2007

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Aims/hypothesis Nocturnal hypoglycaemia may contribute to sudden death in diabetic patients. However, it is not well known why hypoglycaemia makes these patients prone to death. Methods We assessed the effects of controlled hypoglycaemia on cardiac repolarisation using novel electrocardiographic descriptors of T-wave and QRS complex morphology in 16 type 1 diabetic patients and eight healthy counterparts. Several electrocardiographic variables characterising repolarisation were analysed from digitised 12-lead electrocardiograms during a euglycaemic and a hypoglycaemic clamp. Results Hypoglycaemia did not result in significant changes either in the QT interval corrected for heart rate by the nomogram method or in QT dispersion. However, the morphology of the T-wave changed significantly during hypoglycaemia. The T-wave amplitude and area in precordial leads decreased significantly in both groups (p<0.05 to p<0.001). The spatial QRS-T angle (total cosine R to T) (p<0.05) and the height and the width of the T-wave loop (p<0.05 and p<0.01, respectively) were also reduced in the diabetic patients. The changes in the repolarisation parameters did not exhibit any significant association with changes in catecholamine levels or in heart rate variability in either group. Conclusions/interpretation Hypoglycaemia results in distinct alterations in cardiac repolarisation, which may increase the vulnerability to arrhythmic events.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Effects of controlled hypoglycaemia on cardiac repolarisation in patients with type 1 diabetes

et al. 2007

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“…Although several reports have shown that findings on the routine ECG are associated with future HF events,8, 9, 10, 11, 12, 13, 14, 15, 16, 17 few have explored whether ECG predictors vary in their ability to distinguish between HFrEF and HFpEF. A recent examination from the Framingham Heart Study has shown that left ventricular hypertrophy and left bundle‐branch block are associated with HFrEF and that atrial fibrillation is associated with HFpEF 28.…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi‐Ethnic Study of Atherosclerosis

O’Neal

Mazur

Bertoni

et al. 2017

JAHA

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BackgroundSeveral markers detected on the routine 12‐lead ECG are associated with future heart failure events. We examined whether these markers are able to separate the risk of heart failure with reduced ejection fraction (HFrEF) from heart failure with preserved ejection fraction (HFpEF).Methods and ResultsWe analyzed data of 6664 participants (53% female; mean age 62±10 years) from MESA (Multi‐Ethnic Study of Atherosclerosis) who were free of cardiovascular disease at baseline (2000–2002). A competing risks analysis was used to compare the association of several baseline ECG predictors with HFrEF and HFpEF detected during a median follow‐up of 12.1 years. A total of 127 HFrEF and 117 HFpEF events were detected during follow‐up. In a multivariable adjusted model, prolonged QRS duration, delayed intrinsicoid deflection, left‐axis deviation, right‐axis deviation, prolonged QT interval, abnormal QRS‐T axis, left ventricular hypertrophy, ST/T‐wave abnormalities, and left bundle‐branch block were associated with HFrEF. In contrast, higher resting heart rate, abnormal P‐wave axis, and abnormal QRS‐T axis were associated with HFpEF. The risk of HFrEF versus HFpEF was significantly differently for delayed intrinsicoid deflection (hazard ratio: 4.90 [95% confidence interval (CI), 2.77–8.68] versus 0.94 [95% CI, 0.29–2.97]; comparison P=0.013), prolonged QT interval (hazard ratio: 2.39 [95% CI, 1.55–3.68] versus 0.52 [95% CI, 0.23–1.19]; comparison P<0.001), and ST/T‐wave abnormalities (hazard ratio: 2.47 [95% CI, 1.69–3.62] versus 1.13 [95% CI, 0.72–1.77]; comparison P=0.0093).ConclusionsMarkers of ventricular repolarization and delayed ventricular activation are able to distinguish between the future risk of HFrEF and HFpEF. These findings suggest a role for ECG markers in the personalized risk assessment of heart failure subtypes.

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“…An extensive analysis of 12 ECG variables in 38,283 women participating in the Women's Health Initiative found repolarization disorders, signs of MI, and QRS abnormalities to be equally predictive of coronary heart disease morbidity and mortality (11). Repolarization disorders and infarction pattern were also predictors of incident congestive heart failure and all-cause mortality (12). Finally, in atrial fibrillation trials, the preservation of sinus rhythm was associated with a considerable reduction in the risk of death (13,14).…”

Section: Discussionmentioning

confidence: 99%

Electrocardiography and Outcome in Patients with Diabetes Mellitus on Maintenance Hemodialysis

Krane

Heinrich²,

Meesmann³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: In hemodialysis, applicable guidelines recommend regular electrocardiogram (ECG) recordings.However, respective systematic evaluations are absent. Thus, the authors investigated whether routine ECG findings add prognostic information to standard risk assessment in hemodialysis.Design, setting, participants, & measurements: The relationship between nine common baseline ECG variables and a combined cardiovascular endpoint (CVE; cardiac death, myocardial infarction, stroke), sudden death, stroke, MI, and all-cause death in 1253 patients from the German Diabetes and Dialysis Study was evaluated. All patients were on maintenance hemodialysis, had type 2 diabetes mellitus, and received randomized treatment with atorvastatin or placebo.Results: During 4 yr of follow-up (March 1998 to March 2004), 469 patients reached the CVE, and 617 died. After adjustment for demographics, comorbidities, and biomarkers in multivariate analysis, patients presenting without sinus rhythm were 89% more likely to die, and the risk of CVE and stroke increased by 75% and 164%, respectively, compared with patients with preserved sinus rhythm. Left ventricular hypertrophy was associated with >2-fold increase in the risk of stroke and a 60% increase in the risk of sudden death.Conclusions: In hemodialysis patients with type 2 diabetes mellitus, the absence of sinus rhythm is a risk indicator for CVE, stroke, and all-cause death, and left ventricular hypertrophy is associated with stroke and sudden death. Thus, routine ECG recording adds prognostic information to standard risk assessment.

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Electrocardiographic Predictors of Incident Congestive Heart Failure and All-Cause Mortality in Postmenopausal Women

Cited by 124 publications

References 40 publications

Effects of controlled hypoglycaemia on cardiac repolarisation in patients with type 1 diabetes

Effects of controlled hypoglycaemia on cardiac repolarisation in patients with type 1 diabetes

Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi‐Ethnic Study of Atherosclerosis

Electrocardiography and Outcome in Patients with Diabetes Mellitus on Maintenance Hemodialysis

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