Prognostic implications of quantitative ST-segment characteristics and T-wave amplitude for cardiovascular mortality in a general population from the Health 2000 Survey

Anttila, Ismo; Nikus, Kjell; Kähönen, Mika; Jula, Antti; Reunanen, Antti; Salomaa, Veikko; Nieminen, Markku S.; Lehtimäki, Terho; Virtanen, Vesa; Verrier, Richard L.; Varis, Juha; Sclarovsky, Samuel; Nieminen, Tuomo

doi:10.3109/07853890.2010.505932

Cited by 12 publications

(9 citation statements)

References 21 publications

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“…The relative risk for cardiovascular mortality was slightly higher for women than for men, while the opposite was true for CHD mortality. In a former study of the Health 2000 population, the negative prognostic impact of inverted lateral T waves (as a continuous parameter) on cardiovascular mortality was seen only among women (Anttila et al., 2010).…”

Section: Discussionmentioning

confidence: 99%

“…A downsloping ST segment with asymmetric T‐wave inversion in the lateral leads, the “strain pattern,” is a marker of anatomical left ventricular hypertrophy (LVH) and is associated with increased left ventricular mass and mortality (Inoue et al., 2017). Lower T‐wave level as a continuous variable was associated with cardiovascular mortality in women in an earlier study of the Health 2000 population, but this was seen only in the lateral lead group (I, aVL, and V5‐V6) (Anttila et al., 2010).…”

Section: Introductionmentioning

confidence: 91%

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The prognostic significance of T‐wave inversion according to ECG lead group during long‐term follow‐up in the general population

Istolahti

Lyytikäinen

Huhtala

et al. 2020

Noninvasive Electrocardiol

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Background Inverted T waves in the electrocardiogram (ECG) have been associated with coronary heart disease (CHD) and mortality. The pathophysiology and prognostic significance of T‐wave inversion may differ between different anatomical lead groups, but scientific data related to this issue is scarce. Methods A representative sample of Finnish subjects (n = 6,354) aged over 30 years underwent a health examination including a 12‐lead ECG in the Health 2000 survey. ECGs with T‐wave inversions were divided into three anatomical lead groups (anterior, lateral, and inferior) and were compared to ECGs with no pathological T‐wave inversions in multivariable‐adjusted Fine–Gray and Cox regression hazard models using CHD and mortality as endpoints. Results The follow‐up for both CHD and mortality lasted approximately fifteen years (median value with interquartile ranges between 14.9 and 15.3). In multivariate‐adjusted models, anterior and lateral (but not inferior) T‐wave inversions associated with increased risk of CHD (HR: 2.37 [95% confidence interval 1.20–4.68] and 1.65 [1.27–2.15], respectively). In multivariable analyses, only lateral T‐wave inversions associated with increased risk of mortality in the entire study population (HR 1.51 [1.26–1.81]) as well as among individuals with no CHD at baseline (HR 1.59 [1.29–1.96]). Conclusions The prognostic information of inverted T waves differs between anatomical lead groups. T‐wave inversion in the anterior and lateral lead groups is independently associated with the risk of CHD, and lateral T‐wave inversion is also associated with increased risk of mortality. Inverted T wave in the inferior lead group proved to be a benign phenomenon.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

The prognostic significance of T‐wave inversion according to ECG lead group during long‐term follow‐up in the general population

Istolahti

Lyytikäinen

Huhtala

et al. 2020

Noninvasive Electrocardiol

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“…The prognostic significance of T-wave abnormalities has been extensively investigated. For example, the presence of even isolated minor T-wave abnormalities is associated with increased long-term cardiac mortality [ 6 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

The prognostic value of positive T-wave in lead aVR in hemodialysis patients

et al. 2015

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BackgroundGiven that cardiac disease is the leading cause of mortality in hemodialysis (HD) patients, identification of patients at risk for cardiac mortality is crucial. The aim of this study was to determine if positive T-wave amplitude in lead aVR (TaVR) was predictive of cardiovascular (CV) mortality and sudden cardiac death (SCD) in a group of HD patients.Methods and resultsAfter exclusion, 223 HD patients were prospectively followed-up for 25.43 ± 3.56 months. Patients were divided into TaVR negative (n = 186) and TaVR positive (n = 37) groups. Myocardial infarction, diabetes and beta-blocker therapy were more frequent in positive TaVR patients. Patients with upright TaVR were older, had higher left ventricular mass index, lower ejection fraction, higher calcium × phosphate product, higher troponin T level, higher prevalence of ST-T abnormalities, and increased width of QRS complex and QT interval, compared with patients with negative TaVR. A Kaplan–Meier analysis showed that the cumulative incidences of CV mortality as well as SCD were higher in patients with positive TaVR compared with those with negative TaVR (log-rank, p < 0.001 in both cases). A multivariate analysis selected age [hazard ratio (HR) 1.71, p < 0.001], heart rate (HR 1.42, p = 0.016), and positive TaVR (HR 2.21, p = 0.001) as well as age (HR 1.88, p < 0.001), and positive TaVR (HR 1.53, p = 0.014) as independent predictors of CV mortality and SCD, respectively.ConclusionIn HD patients, positive TaVR is an independent and powerful predictor of CV mortality as well as SCD. This simple ECG parameter provides additional information beyond what is available with other known traditional risk factors and allows the identification of patients most at risk of CV events.

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“…All analyses were done separately for men and women because of the previously described gender differences related to the relative ST segment and the T wave in the 12-lead ECG [11]. We also wanted to study gender-specific differences in different lead groups and measurement points.…”

Section: Discussionmentioning

confidence: 99%

“…The prognostic value of ST changes is dependent of the location of the changes within the 12-lead ECG [8,11]. Nevertheless, many authors did not specify the location of ST changes in their analyses.…”

Section: Introductionmentioning

confidence: 99%

Long-term prognostic significance of the ST level and ST slope in the 12‑lead ECG in the general population

Istolahti

Nieminen

Huhtala

et al. 2020

Journal of Electrocardiology

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Background: Even minor ST depression in the electrocardiogram (ECG) is associated with cardiovascular disease and increased mortality. There is limited data on the prognostic significance of ST-level changes in the general population. Subjects and methods: A random sample of Finnish subjects (n = 6354) aged over 30 years (56.1% women) underwent a health examination including a 12-lead ECG in the Health 2000 survey. The effects of relative ST level as a continuous variable and ST slope (upsloping, horizontal, downsloping) in three different lead groups were analyzed using a multi-adjusted Cox proportional hazard model separately for men and women with total mortality as endpoint. Results: The follow-up lasted for 13.7 (SD 3.3) years for men and 13.9 (SD 3.1) years for women. Lower lateral ST levels were associated with all-cause mortality in multi-adjusted models in both genders (at J + 80 ms hazard ratio [HR] 0.64 for a change of 1.0 mm [95% confidence interval 0.49-0.84, p = 0.002] for men and HR 0.61 [0.48-0.78, p b 0.001] for women). Associated coronary heart disease had no major influence on the results. Exclusion of subjects with ECG signs of left ventricular hypertrophy from the analyses increased the mortality risk of lower lateral ST levels in men but decreased it in women. For the anterior and inferior lead groups, no statistically significant difference was seen after multivariate adjustment. ST slope was not an independent predictor of mortality after multivariate adjustment. Conclusion: Lower ST level in the lateral ECG leads is an independent prognostic factor to predict all-cause mortality in the general population.

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Prognostic implications of quantitative ST-segment characteristics and T-wave amplitude for cardiovascular mortality in a general population from the Health 2000 Survey

Cited by 12 publications

References 21 publications

The prognostic significance of T‐wave inversion according to ECG lead group during long‐term follow‐up in the general population

The prognostic significance of T‐wave inversion according to ECG lead group during long‐term follow‐up in the general population

The prognostic value of positive T-wave in lead aVR in hemodialysis patients

Long-term prognostic significance of the ST level and ST slope in the 12‑lead ECG in the general population

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