The predictive value of electrocardiographic abnormalities for total and cardiovascular disease mortality in men and women

Bacquer, D. De; Pereira, L. S. Martins; Backer, Guy De; Henauw, S. De; Kornitzer, Marcel

doi:10.1093/oxfordjournals.eurheartj.a060441

Cited by 33 publications

(23 citation statements)

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“…Importantly and in contrast to QT dispersion, the PCA ratio stratifies risk of CV mortality in both men and women (14), and overall reproducibility of the PCA ratio appears to exceed significantly that of QT dispersion variables (25,26), perhaps contributing to the improved risk stratification offered by this method (14). The present study further demonstrates the strong prognostic value of minor degrees of STD for both CV and all-cause mortality in diabetes, paralleling similar findings in the overall Strong Heart population (3) and the well-established predictive value of minor ST segment abnormalities in other unselected populations (1,2). Importantly in the current study, the predictive value of these ECG measures was independent of measures of glycemic control such as fasting glucose and GHb as well as of the presence or absence of CHD (Tables 2 and 3), factors that might be expected to influence their prognostic value.…”

Section: Discussionsupporting

confidence: 73%

“…Abnormalities of ventricular repolarization on the ECG, such as ST segment depression (STD) and QT interval prolongation, are well-established markers of mortality risk in the general population (1)(2)(3)(4)(5)(6). ECG measures of the heterogeneity or complexity of ventricular repolarization have been implicated in the genesis of ventricular arrhythmias and also associated with adverse prognosis (6 -14).…”

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confidence: 99%

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Electrocardiographic Repolarization Complexity and Abnormality Predict All-Cause and Cardiovascular Mortality in Diabetes

et al. 2004

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Type 2 diabetes is associated with increased risk of cardiovascular (CV) and all-cause mortality. Although electrocardiographic measures of repolarization abnormality and complexity stratify risk in the general population, their prognostic value in diabetes has not been well characterized. Digital electrocardiogram (ECG) readings were acquired for 994 American Indians with type 2 diabetes. ST segment depression (STD) >50 V and rate-corrected QT interval (QTc) >460 ms were examined as measures of repolarization abnormality. The principal component analysis (PCA) of the ratio of the second to first eigenvalues of the T-wave vector (PCA ratio) (>32.0% in women and >24.6% in men) was examined as a measure of repolarization complexity on the ECG. After a mean follow-up of 4.7 ؎ 1.0 years, there were 56 CV deaths and 155 deaths from all causes. In univariate analyses, STD, QTc, and the PCA ratio predicted CV and all-cause mortality. T he surface electrocardiogram (ECG) remains the most widely used noninvasive method for cardiovascular (CV) risk assessment. Abnormalities of ventricular repolarization on the ECG, such as ST segment depression (STD) and QT interval prolongation, are well-established markers of mortality risk in the general population (1-6). ECG measures of the heterogeneity or complexity of ventricular repolarization have been implicated in the genesis of ventricular arrhythmias and also associated with adverse prognosis (6 -14). A number of surface ECG approaches to analysis of repolarization heterogeneity have been proposed, including QT dispersion (6,9,12), T-wave morphology analyses (9,10,13), and principal component analysis (PCA) of the T-wave vector loop (11,14), a spatial measure of T-wave complexity that avoids many of the theoretical and practical limitations of simple QT dispersion and improves prediction of CV death (11,14). However, these repolarization abnormalities may be strongly correlated with one another (11), and whether they provide independent prognostic information when examined together remains unclear.Diabetes is an established risk factor for CV disease and is associated with an increased risk of both all-cause and CV mortality (15)(16)(17)(18)(19). The increasing prevalence of type 2 diabetes, earlier onset of diabetes, and aging of the population will result in an increasing prevalence of diabetesinduced CV disease (18,19), suggesting that accurate noninvasive identification of diabetic individuals at high risk may play a role in the development of more effective preventive strategies for decreasing diabetes-related CV risks (19). Although increased QT interval and QT dispersion have been implicated as possible ECG predictors of CV and all-cause mortality in several small type 2 diabetic cohorts (20 -22), the prognostic value of the QT interval has not been examined in an unselected type 2 diabetic population, and the prognostic value of STD and the more accurate PCA ratio have not been assessed in diabetes. Therefore, the present study examined the value of repolarization abn...

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Section: Discussionsupporting

confidence: 73%

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confidence: 99%

Electrocardiographic Repolarization Complexity and Abnormality Predict All-Cause and Cardiovascular Mortality in Diabetes

et al. 2004

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“…In addition, different studies may vary with regard to the specific ECG classification into major and minor abnormalities (25)(26)(27)(28)(29). The nomenclature of major and minor ECG abnormalities used in this study, although consistent with other publications from the CHS (30,31), does not reflect the current classification according to the Minnesota criteria (32).…”

Section: Discussionmentioning

confidence: 72%

Electrocardiogram Abnormalities and Cardiovascular Mortality in Elderly Patients with CKD

Dobre

Brateanu

Rashidi

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Cardiovascular disease is the most common cause of death in CKD. This study evaluated whether electrocardiogram (ECG) abnormalities are predictors of cardiovascular death in CKD.Design, setting, participants, & measurements The Cardiovascular Health Study limited database (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005) was used to identify a cohort with CKD at baseline (estimated GFR , 60 mL/min per 1.73 m 2 ). The patients were categorized as having major, minor, or no ECG abnormalities. Rates of adjudicated cardiovascular events and mortality were compared among the groups using proportional hazards regression models.Results A total of 1192 participants had CKD at baseline; mean age 6 SD was 74.766.2 years. Of these patients, 452 (38.8%) had major, 346 (29.7%) had minor, and 367 (31.5%) had no ECG abnormalities. Participants with estimated GFR , 60 mL/min per 1.73 m 2 were more likely to have ECG abnormalities at baseline (adjusted prevalence odds ratio, 1.23 [95% confidence interval (CI), 1.06-1.43]) than those with GFR $ 60 mL/min per 1.73 m 2 . During mean follow-up of 10.363.8 years, 814 (68.3%) participants died. Compared with participants without ECG abnormalities, participants with major abnormalities had the highest risk for cardiovascular events and death; adjusted hazard ratios were 2.15 (95% CI, 1.56-2.98) and 2.27 (95% CI, 1.56-3.30), respectively. For minor ECG abnormalities, hazard ratios were 1.24 (95% CI, 0.91-1.70) and 1.48 (95% CI, 1.00-2.18), respectively. ConclusionsIn patients with CKD, major ECG abnormalities are frequently present and predict a significantly higher risk for death and adverse cardiovascular outcomes.

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“…ST-T abnormalities, particularly major abnormalities, are associated with increased risk of CHD incidence and mortality [17][18][19][20][21][22][23][24][25][26][27] . Although the prognostic significance of minor ST-T abnormalities is less conclusive [17][18][19][20] , recent investigations have indicated that minor ST-T abnormalities have a long-term prognostic impact for death from CHD in middle-aged men 26,27) .…”

Section: Introductionmentioning

confidence: 99%

Metabolic Syndrome and Risk of Isolated ST-T Abnormalities and Type 2 Diabetes in Japanese Male Office Workers

Nakanishi

Kashiwakura²,

Nishina

et al. 2005

Ind Health

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The predictive value of electrocardiographic abnormalities for total and cardiovascular disease mortality in men and women

Cited by 33 publications

References 0 publications

Electrocardiographic Repolarization Complexity and Abnormality Predict All-Cause and Cardiovascular Mortality in Diabetes

Electrocardiographic Repolarization Complexity and Abnormality Predict All-Cause and Cardiovascular Mortality in Diabetes

Electrocardiogram Abnormalities and Cardiovascular Mortality in Elderly Patients with CKD

Metabolic Syndrome and Risk of Isolated ST-T Abnormalities and Type 2 Diabetes in Japanese Male Office Workers

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