Impact of Ethnicity on the Prevalence of Early Repolarization Pattern in Children: Comparison Between Caucasian and African Populations

Abstract

The patterns and prevalence of early repolarization pattern (ER in paediatric populations from different ethnic backgrounds other than Caucasian have not been determined. Methods We analyzed ECGs of black children (ages xx-yy) who were prospectively recruited in the northwest Madagascar and compared them to age & sex matched Caucasian ethnicity individuals. ERP was defined by ≥0.1 mV J-point elevation in at least two contiguous inferior and/or lateral ECG leads. Results A total of 616 children were included. There was a trend toward a higher frequency of ERP in the Africans compared to the Caucasians (23.3% vs 17.1% respectively, p=0.053). The subtype (slurred versus notched) and location of ERP (lateral, inferior or infero-lateral) were significantly different in the two groups (p<0.001 and p=0.020, respectively). There was no significant difference in the number of high-risk ECG features of ERP (i.e. horizontal/descendent pattern, inferior or infero-lateral location or J-waves ≥2 mm) between Malagasy and Caucasian children. On the multivariate analysis, Malagasy ethnicity and faster heart rate were independent predictive factors of ERP (OR 3.57, 95%CI 2.04-6.25, p<0.001 and 0.98, 95%CI 0.962-0.987, p<0.001, respectively). Conclusions African children have an increased risk of ER compared to Caucasian counterparts. Future studies should clarify the clinical and prognostic significance of ERP in the pediatric population, and whether ethnicity has an impact on the outcomes.

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

“…According to our pooled analyzed prevalence, ERP is approximately twice as common in blacks as in Caucasians, which is similar to previous studies [20,27,62] . Olson et al reported that 24.4% of blacks versus 7.9% of whites had J-point elevation based on Atherosclerosis Risk in Communities (ARIC) study [20,62] .…”

“…[ 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.…”

“…According to our pooled analyzed prevalence, ERP is approximately twice as common in blacks as in Caucasians, which is similar to previous studies. [ 20 , 27 , 62 ] Olson et al reported that 24.4% of blacks versus 7.9% of whites had J-point elevation based on Atherosclerosis Risk in Communities (ARIC) study. [ 20 , 62 ] Considering correlation between ECG variations and body composition proposed in previous studies, [ 63 , 64 ] differences in body build, composition, and nutrition might in part explain the clinical differences in prevalence among races.…”