Long-term prognostic significance of isolated minor electrocardiographic T-wave abnormalities in middle-aged men free of clinical cardiovascular disease (The Multiple Risk Factor Intervention Trial [MRFIT])

ArticleinThe American Journal of Cardiology 90(12):1391-5 · January 2003with4 Reads
DOI: 10.1016/S0002-9149(02)02881-3 · Source: PubMed
Abstract
The presence or new onset of isolated minor T-wave abnormalities (Minnesota Code 5.3 or 5.4) associated with a greater spatial T-axis deviation was shown to be independently predictive of long-term (18.5 years) cardiovascular disease and coronary heart disease mortality. This was tested in a cohort of >11,000 middle-aged men who were free of clinical coronary heart disease in the Multiple Risk Factor Interventional Trial.
    • "To our knowledge, this is the first study that has demonstrated the prognostic utility of upright TaVR for predicting SCD. Given the ubiquity, inexpensiveness and convenience of ECG recordings and the fact that SCD is the single largest cause of death in HD patients123 5], the results of TaVR might be readily utilized for SCD risk estimation in HD patients. It currently remains unclear whether upright TaVR is merely a marker of poor prognosis that reflects the high prevalence of the most severe forms of coronary artery disease, contributing to CV mortality, including SCD, or whether it potentially identifies more distinct electrophysiological mechanisms that underlie increased mortality and SCD. "
    [Show abstract] [Hide abstract] ABSTRACT: Given 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. After 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. In 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.
    Full-text · Article · Feb 2015
    • "Two prospective population-based reports on T wave axis deviation measured from standard 12-lead ECGs in older populations (the Rotterdam study [23], and Cardiovascular Health Study (CHS) [24] suggest that it is an indicator of increased risk of coronary heart disease and total mortality, independent of other cardiovascular risk factors. In the cohort of high-risk, middle-aged men from the Multiple Risk Factor Intervention Trial (MRFIT), baseline spatial T wave axis deviation was not significantly associated with incident coronary events, although the change over time in the spatial T wave axis deviation was reported to be associated with incident events on long-term follow-up [25]. These studies suggest that spatial T wave axis deviations capture changes in the ventricular repolarization process that are of potential clinical and epidemiologic importance. "
    [Show abstract] [Hide abstract] ABSTRACT: Although current evidence suggests that the spatial T wave axis captures important information about ventricular repolarization abnormalities, there are only a few and discordant epidemiologic studies addressing the ability of the spatial T wave axis to predict coronary heart disease (CHD) occurrence. This prospective study analyzed data from 12,256 middle-aged African American and white men and women, from the Atherosclerosis Risk in Communities Study (ARIC). Following a standardized protocol, resting standard 12-lead, 10-second electrocardiograms were digitized and analyzed with the Marquette GE program. The median follow-up time was 12.1 years; incident coronary heart disease comprised fatal and non-fatal CHD events. The incidence rate of CHD was 4.26, 4.18, 4.28 and 5.62 per 1000 person-years respectively, across the spatial T wave axis quartiles. Among women for every 10 degrees increase in the spatial T wave axis deviation, there was an estimated increase in the risk of CHD of 1.16 (95% CI 1.04-1.28). After adjustment for age, height, weight, smoking, hypertension, diabetes, QRS axis and minor T wave abnormalities, this hazard rate ratio for women fell to 1.03 (0.92-1.14). The corresponding crude and adjusted hazard ratios for men were 1.05 (95% CI 0.96-1.15) and 0.95 (0.86-1.04) respectively. In conclusion, this prospective, population-based, bi-ethnic study of men and women free of coronary heart disease at baseline shows that spatial T wave axis deviation is not associated with incident coronary events during long-term follow up. It is doubtful that spatial T wave axis deviation would add benefit in the prediction of CHD events above and beyond the current traditional risk factors.
    Full-text · Article · Feb 2005
    • "The spatial QRS-T angle and spatial T amplitude do not differentiate between recent (5-10 days) and old (>6 months) MI, but distinguish them from healthy controls (Dilaveris et al. 2001). Minor T-wave abnormalities (Minnesota Code 5.3 or 5.4) have independent long-term (6 years and 18.5 years) prognostic value for CHD and cardiovascular mortality in a cohort of men at high risk but free of CHD at entry (Prineas et al. 2002). Spatial T-axis deviation has independent prognostic value, in a cohort of elderly (65 years) men and women free of CHD at entry, with regard to CHD death (adjusted hazard ratio 2.0), incident CHD (adjusted hazard ratio 1.6), and all-cause mortality (adjusted hazard ratio 1.5). "
    [Show abstract] [Hide abstract] ABSTRACT: The aim of the studies was to improve the diagnostic capability of electrocardiography (ECG) in detecting myocardial ischemic injury with a future goal of an automatic screening and monitoring method for ischemic heart disease. The method of choice was body surface potential mapping (BSPM), containing numerous leads, with intention to find the optimal recording sites and optimal ECG variables for ischemia and myocardial infarction (MI) diagnostics. The studies included 144 patients with prior MI, 79 patients with evolving ischemia, 42 patients with left ventricular hypertrophy (LVH), and 84 healthy controls. Study I examined the depolarization wave in prior MI with respect to MI location. Studies II-V examined the depolarization and repolarization waves in prior MI detection with respect to the Minnesota code, Q-wave status, and study V also with respect to MI location. In study VI the depolarization and repolarization variables were examined in 79 patients in the face of evolving myocardial ischemia and ischemic injury. When analyzed from a single lead at any recording site the results revealed superiority of the repolarization variables over the depolarization variables and over the conventional 12-lead ECG methods, both in the detection of prior MI and evolving ischemic injury. The QT integral, covering both depolarization and repolarization, appeared indifferent to the Q-wave status, the time elapsed from MI, or the MI or ischemia location. In the face of evolving ischemic injury the performance of the QT integral was not hampered even by underlying LVH. The examined depolarization and repolarization variables were effective when recorded in a single site, in contrast to the conventional 12-lead ECG criteria. The inverse spatial correlation of the depolarization and depolarization waves in myocardial ischemia and injury could be reduced into the QT integral variable recorded in a single site on the left flank. In conclusion, the QT integral variable, detectable in a single lead, with optimal recording site on the left flank, was able to detect prior MI and evolving ischemic injury more effectively than the conventional ECG markers. The QT integral, in a single-lead or a small number of leads, offers potential for automated screening of ischemic heart disease, acute ischemia monitoring and therapeutic decision-guiding as well as risk stratification. Perinteinen sydäninfarktin ja sepelvaltimotautikohtauksen elektrokardiografinen (EKG) diagnostiikka perustuu laadullisiin piirteisiin 12-kytkentäisessä EKG:ssa. Väitöskirjatutkimuksen tarkoituksena oli parantaa EKG-diagnostiikkaa sydäninfarktin ja iskemian havaitsemisessa.. Lopullisena päämääränä on kehittää iskeemisen sydänsairauden automaattinen seulonta- ja monitorointimenetelmä. Väitöskirjatutkimuksen osatyöt tähtäsivät sydäninfarkti- ja iskemiadiagnostiikassa parhaiden rekisteröintipaikkojen löytämiseen yksittäisissä kytkennöissä ja parhaiden kvantitatiivisten EKG-muuttujien löytämiseen. Tutkimuksen työkaluna käytettiin sydänsähkökäyrän kehokartoitusta (body surface potential mapping, BSPM), jossa sydämen tuottamaa sähköistä potentiaalia rekisteröidään koko ylävartalon alueelta lukuisten elektrodien avulla. Tutkimushenkilöinä oli 144 aiemmin sydäninfarktin sairastanutta potilasta, 79 potilasta, joilla oli äkillinen sepelvaltimotautikohtaus, 42 potilasta, joilla oli vasemman kammion hypertrofia ja 84 tervettä vapaaehtoista. Sydäninfarkti ja sepelvaltimotauti varmennettiin tai paikannettiin sepelvaltimoiden ja vasemman kammion varjoainekuvauksella, sydämen kaikukuvauksella, sydänlihasmerkkiaineilla tai sydämen magneettitutkimuksella. Osatutkimuksissa I-V tarkasteltiin sydämen sähköistä aktivoitumis- ja palautumisvaiheita eli depolarisaatio- ja repolarisaatiovaiheita kuvaavia muuttujia aiemman sydäninfarktin diagnostiikassa sekä paikannuksessa perinteiseen EKG-diagnostiikkaan verrattuna. Kuudennessa osatutkimuksessa näitä muuttujia tarkasteltiin äkillisen sepeolvaltimotautikohtauksen aikana. Sydämen sähköisen palautumis- eli repolarisaatiovaiheen muuttujat EKG:ssa osoittautuivat aktivaatio- eli depolarisaatiovaiheen muuttujia paremmiksi sekä aiemman sydäninfarktin että äkillisen sepelvaltimotautikohtauksen diagnostiikassa Yhdestä kytkennästä rekisteröitävä QT-integraali, joka käsittää sekä sähköisen aktivaatio- että palautumisvaiheen, osoittautui vakaaksi diagnostiseksi muuttujaksi ja riippumattomaksi infarktin iästä, sijainnista, vasemman kammion hypertrofiasta tai mahdollisesta Q-aallosta ja oli perinteisiä EKG:n tulkintatapoja tehokkaampi. Tämä muuttuja tarjoaa mahdollisuuksia sepelvaltimotaudin automaattiseen seulontaan ja äkillisen sepelvaltimotautikohtauksen monitorointiin hoitopäätöksiä ja riskinarviointia ajatellen.
    Article · · BMC Cardiovascular Disorders
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