Impact of minor electrocardiographic ST-segment and/or T-wave abnormalities on cardiovascular mortality during long-term follow-up

Greenland, Philip; Xie, Xueyi; Liu, Kiang; Colangelo, Laura A.; Liao, Youlian; Daviglus, Martha L.; Agulnek, Abby N.; Stamler, Jeremiah

doi:10.1016/s0002-9149(03)00150-4

Cited by 131 publications

(98 citation statements)

References 25 publications

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“…The long-term importance of these findings as markers for coronary heart disease, cardiovascular death and sudden cardiac death has been confirmed by epidemiological and forensic studies[18,19,20]. Whether ST/T abnormalities play a role as prognostic indicators in LVHT patients is at present unknown.…”

Section: Discussionmentioning

confidence: 99%

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Association of Electrocardiographic Abnormalities with Cardiac Findings and Neuromuscular Disorders in Left Ventricular Hypertrabeculation/Non-Compaction

Stöllberger

Winkler-Dworak²,

Blazek³

et al. 2007

Cardiology

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Introduction and Objectives: Left ventricular hypertrabeculation/non-compaction (LVHT) is a cardiac abnormality characterized by prominent trabeculations and intertrabecular recesses, and frequently associated with neuromuscular disorders (NMD). The aim of the study was to assess the prevalence of electrocardiographic (ECG) abnormalities in LVHT and its association with clinical symptoms, left ventricular size, wall thickness, systolic function, location and extension of LVHT and presence or absence of NMD. Methods and Results: In 86 patients LVHT was diagnosed echocardiographically between June 1995 and December 2004 (21 female, 65 male, age: 14–94 years, mean age: 52 ± 14 years). All patients underwent a baseline cardiologic investigation and were invited for a neurologic investigation. A specific NMD was diagnosed in 21 (metabolic myopathy, n = 14; Leber’s hereditary optic neuropathy, n = 3; myotonic dystrophy, n = 2; Becker muscular dystrophy, n = 1; Duchenne muscular dystrophy, n = 1), a NMD of unknown etiology in 32, the neurologic investigation was normal in 13, and 20 patients refused. Only 9 patients (10%) had normal ECGs. Frequent ECG abnormalities were tall QRS complexes (43%); ST/T-wave abnormalities (37%) and left bundle branch block (20%). ECG abnormalities were related with symptoms of heart failure and echocardiographic findings of systolic dysfunction and valvular abnormalities. Only atrial fibrillation (9%) was related to extension of LVHT. ECG abnormalities did not differ between patients with and without NMD. Conclusion: ECG abnormalities are frequent in LVHT. A normal ECG, however, does not exclude LVHT. No ECG pattern is typical for LVHT. ECG abnormalities occur independently of presence or absence of NMD, and thus all patients with LVHT should be referred to the neurologist.

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Section: Discussionmentioning

confidence: 99%

“…ST/T-wave abnormalities are a rather common ECG abnormality of otherwise healthy persons[ 16,18,19,20]. The long-term importance of these findings as markers for coronary heart disease, cardiovascular death and sudden cardiac death has been confirmed by epidemiological and forensic studies[18,19,20].…”

Section: Discussionmentioning

confidence: 99%

Association of Electrocardiographic Abnormalities with Cardiac Findings and Neuromuscular Disorders in Left Ventricular Hypertrabeculation/Non-Compaction

Stöllberger

Winkler-Dworak²,

Blazek³

et al. 2007

Cardiology

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“…[15][16][17] Earlier reports that included large numbers of women and men [15][16][17] predominantly demonstrated significant predictive value of standard ECG measures of old MI and major and minor repolarization abnormalities by Minnesota coding for cardiovascular and all-cause mortality. In all of these studies, however, identical criteria were used in men and women despite known gender differences in many of these variables, which potentially underestimated the value of these findings in women.…”

Section: Articles Pp 473 and 481mentioning

confidence: 99%

Electrocardiography in Women

Okin

2006

Circulation

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In the just over 100 years since the first ECG was performed, 1 the ECG has become the most extensively used noninvasive diagnostic and prognostic tool in cardiology. Used both at rest and during provocative exercise, the 12-lead ECG has impressive, if imperfect, utility for rhythm analysis, detection of ischemic and hypertrophic heart disease, and outcome prediction in a variety of clinical settings, with a large body of literature that illustrates and supports these applications. The first observation of gender differences in the ECG was published 85 years ago by Bazett, 2 demonstrating that women have significantly longer QT intervals than men despite having higher heart rates. However, despite a growing body of literature demonstrating significant gender differences in QRS amplitudes and duration, [3][4][5][6]5,7,8 ST-segment deviation, 9,10 and novel, computer-based measurements of T-wave complexity, 8,11 few ECG criteria routinely use gender-specific diagnostic criteria, and there has been a relative paucity of data on the prognostic performance of ECG variables in women. Articles pp 473 and 481Two studies in the current issue of Circulation by Rautaharju and colleagues 12,13 provide a wealth of new findings and impetus for further study of the ECG in women. Using well-validated computerized ECG methodology, the authors examined the value of a number of ECG variables for predicting incident coronary heart disease and its mortality, incident congestive heart failure, and total mortality in more than 38 000 women participating in the dietary modification trial of the Women's Health Initiative. Although both studies reconfirm the predictive value of ECG evidence of prior Q-wave myocardial infarction (MI), the principle new findings are the strong predictive value of various ECG measures of repolarization, and in particular of the QRS/T angle, 12,13 a measure of the spatial angle between mean QRS and T vectors. In the single-ECG multivariable models that adjusted for standard demographic and clinical risk factors, nearly all T-wave and ST-segment variables and the QRS/T angle, as well as novel measures of repolarization derived from singular value decomposition of the derived vectorcardiogram, were significant predictors of outcome. When all ECG variables were examined together in these models, the QRS/T angle retained its predictive value along with a number of other ECG measures, including rate-corrected QT interval, heart rate variability, and ECG evidence of prior Q-wave MI.These 2 reports build on a number of previous studies that examined the prognostic value of the ECG in women alone 14 or compared predictive value in men and women. [15][16][17] Earlier reports that included large numbers of women and men [15][16][17] predominantly demonstrated significant predictive value of standard ECG measures of old MI and major and minor repolarization abnormalities by Minnesota coding for cardiovascular and all-cause mortality. In all of these studies, however, identical criteria were used in men and women despit...

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“…Lead aVR, an augmented and unipolar limb lead, was constructed to obtain specific information from the right upper position of the heart, including the outflow tract of the right ventricle and the basal portion of the interventricular septum. Although numerous studies have examined the association of T-wave abnormalities with cardiovascular events [10,11,12,13], the significance of an abnormality of T-wave in lead aVR (aVRT) has not been fully explored. Recently, a retrospective cohort study including 24,270 male veterans whose ECGs were obtained for any clinical reasons evaluated the diagnostic value of an upright aVRT and showed an association between the T-wave amplitude in lead aVR and cardiovascular mortality during a mean follow-up period of 4 years [14].…”

Section: Introductionmentioning

confidence: 99%

Usefulness of an Upright T-Wave in Lead aVR for Predicting the Short-Term Prognosis of Incident Hemodialysis Patients: A Potential Tool for Screening High-Risk Hemodialysis Patients

et al. 2015

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Background/Aims: An upright T-wave in lead aVR (aVRT) has recently been reported to be associated with cardiovascular death and mortality among the general population and patients with prior cardiovascular disease (CVD). However, evidence for the predictive ability of aVRT in patients with chronic kidney disease is lacking. Therefore, a hospital-based, prospective, cohort study was conducted to evaluate the predictive ability of an upright aVRT for the short-term prognosis in incident hemodialysis patients. Methods: Among 208 patients who started maintenance hemodialysis, 79 with preexisting CVD (CVD cohort) and 129 with no history of CVD (non-CVD cohort), were studied. An upright and non-upright aVRT were defined as a wave with a positive deflection in amplitude of ≥0 mV and a negative deflection in amplitude of <0 mV, respectively. The endpoint was all-cause death. Results: Overall, the prevalence of an upright aVRT was 22.6% at baseline. During the mean follow-up period of 2.1 ± 1.0 years, 33 deaths occurred. Cumulative survival rates at 3 years after starting dialysis in patients with an upright and non-upright aVRT were 50.0 and 80.7%, respectively, in the CVD cohort and 92.0 and 91.3%, respectively, in the non-CVD cohort. In the CVD cohort, multivariate Cox regression analysis showed that an upright aVRT was an independent predictor of death after adjusting for confounding variables. Conclusion: Among Japanese hemodialysis patients at high risk for CVD, an upright aVRT seems to be useful for predicting death.

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Impact of minor electrocardiographic ST-segment and/or T-wave abnormalities on cardiovascular mortality during long-term follow-up

Cited by 131 publications

References 25 publications

Association of Electrocardiographic Abnormalities with Cardiac Findings and Neuromuscular Disorders in Left Ventricular Hypertrabeculation/Non-Compaction

Association of Electrocardiographic Abnormalities with Cardiac Findings and Neuromuscular Disorders in Left Ventricular Hypertrabeculation/Non-Compaction

Electrocardiography in Women

Usefulness of an Upright T-Wave in Lead aVR for Predicting the Short-Term Prognosis of Incident Hemodialysis Patients: A Potential Tool for Screening High-Risk Hemodialysis Patients

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