Prevalence, Prognosis, and Implications of Isolated Minor Nonspecific ST-Segment and T-Wave Abnormalities in Older Adults

Abstract

Background-The prevalence and prognostic significance of isolated minor nonspecific ST-segment and T-wave abnormalities (NSSTTAs) in older adults are poorly understood. Methods and Results-Cardiovascular Health Study participants free of both clinical cardiovascular disease and major ECG abnormalities were included. We examined the prospective association of isolated minor NSSTTAs (defined by Minnesota Codes 4 -3, 4 -4, 5-3, and 5-4) with total, cardiovascular, and coronary mortality and incident nonfatal myocardial infarction. Among 3224 participants (61.9% women; mean age, 72 years), 233 (7.2%) had isolated NSSTTAs at baseline. Covariates associated with isolated NSSTTAs included older age, nonwhite race (20.5% of blacks versus 4.8% of whites; PϽ0.001), diabetes, and higher blood pressure and body mass index but not the presence of subclinical cardiovascular disease. After 39 518 person-years of follow-up, the presence of isolated NSSTTAs was associated with significantly increased risk for coronary heart disease mortality (multivariable-adjusted hazards ratio, 1.76; 95% CI, 1.18 to 2.61) but not with incident nonfatal myocardial infarction (multivariable-adjusted hazards ratio, 0.71; 95% CI, 0.43 to 1.17). The association of isolated NSSTTAs with coronary death was independent of subclinical atherosclerosis and left ventricular mass measures. In secondary analyses, among those with cardiac death, there was a significantly higher rate of primary arrhythmic death (32.3% versus 15.4%; Pϭ0.02) in participants with isolated NSSTTAs versus those without NSSTTAs. Conclusions-Isolated NSSTTAs are common in older Americans and are associated with significantly increased risk for coronary death. However, isolated NSSTTAs are not associated with incident nonfatal myocardial infarction, suggesting that they are associated particularly with increased risk for primary arrhythmic death.

Ischemic Electrocardiographic Abnormalities and Prognosis in Decompensated Heart Failure

“…In the Cardiovascular Health Study, the association between minor nonspecific ST-segment or T-wave abnormalities and cardiovascular mortality was attributed to an increased risk of arrhythmias. 24 The mechanisms involved in the failing heart, however, are likely more complex. In a study of 11 327 patients with chronic heart failure, isolated electrocardiographic abnormalities, including ST-T abnormalities and presence of Q-waves, were not associated with major structural disease or significant left ventricular dysfunction.…”

2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults

“…Randomized studies have demonstrated that lipid-lowering therapies reduce Lp-PLA2, although there may be some variability by medication type (197,198). Drugs under development that specifically inhibit Lp-PLA2 activity have been shown to lower Lp-PLA2 activity and inflammatory markers (199 Epidemiological studies have shown that abnormalities on a resting 12-lead ECG are predictive of subsequent mortality and cardiovascular events among asymptomatic adults (200,202,205,206). Specific electrocardiographic findings that have been linked to cardiovascular risk in populationbased cohorts and asymptomatic patients with hypertension include LVH (especially when accompanied by repolarization changes), QRS prolongation, ST-segment depression, T-wave inversion, and pathological Q waves (202,(207)(208)(209)(210)(211).…”

Electrocardiogram reports in a cardiology tests clinic

“…This fact suggests that ST-segment unspecific abnormalities are particularly associated with risk for death due to primary arrhythmia. 11 In our cohort, the presence of atrial or ventricular extrasystoles was observed in 3.4% of cases of the general sample, and its higher frequency occurred in the groups of individuals who performed the test due to tachycardia (11.7%). It is known that the presence of extrasystoles has prognostic value for heart disease, and it has been shown that frequent ventricular extrasystoles after physical exercise works as a death predictor.…”