Clinical Significance of Minor Nonspecific ST-Segment and T-Wave Abnormalities in Asymptomatic Subjects: A Systematic Review

Abstract

The purpose of the study is to examine the prevalence and significance of minor nonspecific ST-segment and T-wave abnormalities (NSSTTA) in the prediction of future cardiovascular disease (CVD) events. Minor NSSTTA are commonly encountered in clinical practice. To date, there have been no systematic reviews focusing on the prevalence and prognostic importance of these findings. Literature searches of MEDLINE (1966-2005) were supplemented with searches of bibliographies from key articles. We focused on isolated minor NSSTTA in healthy middle-aged or elderly populations, including men, women, blacks, and whites, and the association of isolated minor NSSTTA with incident cardiovascular and coronary events. Isolated minor NSSTTA are common in middle-aged white men (ranging from 3.6% to 10.3%), and seem to be even more prevalent in women, blacks, and the elderly. In the 3 studies that examined isolated minor NSSTTA, the multivariable-adjusted hazard ratios for coronary mortality ranged from 1.24 to 1.66. Although gender, race, and age-specific differences in the prognostic significance of minor NSSTTA are not clear because of limited data, minor NSSTTA in asymptomatic patients are an important risk factor for coronary and cardiovascular mortality, independent of traditional risk factors. Minor NSSTTA are prevalent in asymptomatic individuals, and they confer increased risk for CVD and coronary heart disease (CHD), independent of traditional risk factors. Future studies with standardized methodology are needed to elucidate the physiological significance of minor NSSTTA and to further describe gender, race, and age-related differences in the prevalence and prognostic significance of minor NSSTTA.

Association of Traditional Cardiovascular Risk Factors With Development of Major and Minor Electrocardiographic Abnormalities

“…1 Such ECG abnormalities sometimes represent markers of underlying cardiac structural abnormalities (eg, left ventricular hypertrophy [LVH]) or dysrhythmias that directly increase the risk for CVD events. In other situations, the mechanisms of association are less clear, such as with minor isolated ST-segment and T-wave abnormalities (STTA).…”

“…In other situations, the mechanisms of association are less clear, such as with minor isolated ST-segment and T-wave abnormalities (STTA). 1 The prevalence of major and minor ECG abnormalities increases substantially with age. 2 However, it is unclear whether the development of prognostically significant ECG abnormalities is solely attributable to aging or heritable factors or whether modifiable traditional risk factors are associated with their development prospectively.…”

Electrocardiographic Abnormalities in Disease-Free Black South Africans and Correlations With Echocardiographic Indexes and Early Repolarization

“…A longitudinal study of nearly 10 000 Caucasian adults with a rate of ECG abnormalities at approximately 30% showed an increased risk of mortality with ST depression, second or third degree heart block, complete bundle branch blocks, frequent extra systoles, atrial fibrillation/flutter and T wave inversions (RR = 2.79) 11 . Other studies in large Caucasian cohorts have found similar predictive value of LVH by Sokolow-Lyon LVH voltage criteria (RR1.16), prolonged QTc (RR1.2) 12 and minor degrees of ST/T wave changes (ST depression <0.5mV, T wave inversion <0.1mV) (OR 1.24-1.66) 13 . Similarly, ECGs have also been used as a marker for chamber enlargement, but with suboptimal reliability.…”

Clinical features of aviators with coronary artery disease diagnosed by multislice CT angiography

“…A few decades ago those minor abnormalities of ST segment and T wave had been accepted nonspecific in an asymptomatic aircrew and a negative TT could easily be qualified for the flight (14). But new imaging modalities such as MSCT documented that minor nonspecific ST segment and T wave abnormalities in an asymptomatic patient might have been specific indicator for coronary artery disease and cardiovascular mortality (15). Additionally in a recent study at the end of 24 year follow up of Japanese men and women it was reported that ST segment depression and/or T wave changes on resting ECG were significantly correlated with cardiovascular mortality.…”