Electrocardiographic Predictors of Cardiovascular Outcome in Women

Triola, Brian; Olson, Marian B.; Reis, Steven E.; Rautaharju, Pentti M.; Merz, C. Noel Bairey; Kelsey, Sheryl F.; Shaw, Leslee J.; Sharaf, Barry L.; Sopko, George; Saba, Samir

doi:10.1016/j.jacc.2004.09.082

Cited by 57 publications

(20 citation statements)

References 20 publications

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“…Although several reports have shown that findings on the routine ECG are associated with future HF events,8, 9, 10, 11, 12, 13, 14, 15, 16, 17 few have explored whether ECG predictors vary in their ability to distinguish between HFrEF and HFpEF. A recent examination from the Framingham Heart Study has shown that left ventricular hypertrophy and left bundle‐branch block are associated with HFrEF and that atrial fibrillation is associated with HFpEF 28.…”

Section: Discussionmentioning

confidence: 99%

“…A number of studies have demonstrated that several markers detected on the routine ECG are associated with future HF events8, 9, 10, 11, 12, 13, 14, 15, 16, 17; however, it is currently unknown if a differential risk profile exists for these ECG markers in the prediction of HFrEF versus HFpEF. The ability to identify specific predictors for HFrEF and HFpEF is an important step to target appropriate preventive strategies for each HF subtype.…”

Section: Introductionmentioning

confidence: 99%

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Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi‐Ethnic Study of Atherosclerosis

O’Neal

Mazur

Bertoni

et al. 2017

JAHA

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BackgroundSeveral markers detected on the routine 12‐lead ECG are associated with future heart failure events. We examined whether these markers are able to separate the risk of heart failure with reduced ejection fraction (HFrEF) from heart failure with preserved ejection fraction (HFpEF).Methods and ResultsWe analyzed data of 6664 participants (53% female; mean age 62±10 years) from MESA (Multi‐Ethnic Study of Atherosclerosis) who were free of cardiovascular disease at baseline (2000–2002). A competing risks analysis was used to compare the association of several baseline ECG predictors with HFrEF and HFpEF detected during a median follow‐up of 12.1 years. A total of 127 HFrEF and 117 HFpEF events were detected during follow‐up. In a multivariable adjusted model, prolonged QRS duration, delayed intrinsicoid deflection, left‐axis deviation, right‐axis deviation, prolonged QT interval, abnormal QRS‐T axis, left ventricular hypertrophy, ST/T‐wave abnormalities, and left bundle‐branch block were associated with HFrEF. In contrast, higher resting heart rate, abnormal P‐wave axis, and abnormal QRS‐T axis were associated with HFpEF. The risk of HFrEF versus HFpEF was significantly differently for delayed intrinsicoid deflection (hazard ratio: 4.90 [95% confidence interval (CI), 2.77–8.68] versus 0.94 [95% CI, 0.29–2.97]; comparison P=0.013), prolonged QT interval (hazard ratio: 2.39 [95% CI, 1.55–3.68] versus 0.52 [95% CI, 0.23–1.19]; comparison P<0.001), and ST/T‐wave abnormalities (hazard ratio: 2.47 [95% CI, 1.69–3.62] versus 1.13 [95% CI, 0.72–1.77]; comparison P=0.0093).ConclusionsMarkers of ventricular repolarization and delayed ventricular activation are able to distinguish between the future risk of HFrEF and HFpEF. These findings suggest a role for ECG markers in the personalized risk assessment of heart failure subtypes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi‐Ethnic Study of Atherosclerosis

O’Neal

Mazur

Bertoni

et al. 2017

JAHA

View full text Add to dashboard Cite

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“…Vectorcardiographic (VCG) principles (3-dimensional parameters, derived from a 12-lead electrocardiogram) have provided additional diagnostic [14, 15] and prognostic [16–20] information, building upon the traditional 12-lead ECG. Dispersion of ventricular depolarization, as measured by the QRS vector magnitude has had predictive value in ventricular arrhythmia development pre-operatively and peri-operatively in patients with congenital heart disease, independent of QRSd [21, 22].…”

Section: Introductionmentioning

confidence: 99%

Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients

Cortez

Baturova

Lindgren

et al. 2017

BMC Cardiovasc Disord

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BackgroundAtrial fibrillation (AF) is a known risk factor for ischemic stroke. Electrocardiographic predictors of AF in population studies such as the Framingham Heart Study, as well as in hypertensive patients have demonstrated a predictive value of the P-wave duration for development of AF. QRS vector magnitude has had a predictive value in ventricular arrhythmia development. We aimed to assess the value of the three-dimensional P-wave vector magnitude and its relationship to P-wave duration for prediction of new-onset AF after ischemic stroke.MethodsFirst-ever ischemic stroke patients without AF at inclusion in the Lund Stroke Register were included. Measurements of P wave duration (Pd), QRS duration, corrected QT interval, and PQ interval were performed automatically using the University of Glasgow 12-lead ECG analysis algorithm. The P-wave vector magnitude (Pvm) was calculated automatically as the square root of the sum of the squared P-wave magnitudes in leads V6, II and one half of the P-wave amplitude in V2 (), based on the P-wave magnitude (Pvm) as defined by the visually transformed Kors’ Quasi-orthogonal method.ResultsThe median age was 73 (IQR 63–80) years at stroke onset (135 males, 92 females). Multivariate predictors of new-onset atrial fibrillation included age > 65 years, hypertension, and Pd/Pvm. A cut-off value of 870 ms/mV gave sensitivity, specificity, positive and negative predictive values of 51, 79, 30 and 87%, respectively. The Pd/Pvm was the only ECG predictor of AF with a significant multivariate hazard ratio of 2.02 (95% CI 1.18 to 3.46, p = 0.010).ConclusionP-wave dispersion as measured by the Pd/Pvm was the only ECG parameter measured which independently predicted subsequent AF identification in a cohort of stroke patients. Further prospective studies in larger cohorts are needed to validate its clinical usefulness.

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“…However, in the Women's Ischemia Syndrome Study (WISE), a wide QRS/T angle, QRS duration, and prolonged QT interval were independent predictors of incident fatal and nonfatal coronary heart disease events, but the QRS nondipolar voltage was not. 24 The question of the mechanism for increased risk of incident HF for QRS nondipolar voltage in women remains open.…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic Predictors of Incident Heart Failure in Men and Women Free From Manifest Cardiovascular Disease (from the Atherosclerosis Risk in Communities [ARIC] Study)

Rautaharju

Zhang

Haisty

et al. 2013

The American Journal of Cardiology

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The risk of incident hospitalized heart failure (HF) was evaluated for 23 electrocardiographic (ECG) variables in men and women free from cardiovascular disease. The hazard ratios with 95% confidence intervals were determined from Cox regression analysis for 13,428 participants 45 to 65 years old in the Atherosclerosis Risk in Communities (ARIC) study. New-onset HF during a 14-year follow-up period occurred in 695 men (11.9%) and 721 women (9.5%). Several ECG variables were significant predictors of incident HF when evaluated as single ECG variables. Predominant among them were spatial angles, reflecting deviations of the direction of the repolarization sequence from the normal reference direction. After controlling for collinearity among the ECG variables, the spatial angle between T peak and normal T reference vectors, Θ(Tp|Tref), was a significant independent predictor in men (HF risk increased 31%) and women (HF risk increased 46%). Other independent predictors in men included epicardial repolarization time (62% increased risk) and T wave peak to T wave end (TpTe) interval, reflecting global dispersion of repolarization (27% increased risk). The independent predictors in women, in addition to Θ(Tp|Tref), were Θ(R|STT) the spatial angle between the mean QRS and STT vectors (54% increased risk) and QRS nondipolar voltage (46% increased risk). In conclusion, wide Θ(Tp|Tref), wide Θ(R|STT), and increased QRS nondipolar voltage in women and wide Θ(Tp|Tref), increased epicardial repolarization time, prolonged TpTe interval and T wave complexity in men were independent predictors of incident HF, and the presence of these abnormal findings could warrant additional diagnostic evaluation for possible preventive action for HF.

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Electrocardiographic Predictors of Cardiovascular Outcome in Women

Abstract: Several 12-lead ECG parameters, such as the QRS-T angle and the QRS and QTrr duration, are predictive of future cardiovascular events in women with suspected myocardial ischemia.

Cited by 57 publications

References 20 publications

Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi‐Ethnic Study of Atherosclerosis

Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi‐Ethnic Study of Atherosclerosis

Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients

Electrocardiographic Predictors of Incident Heart Failure in Men and Women Free From Manifest Cardiovascular Disease (from the Atherosclerosis Risk in Communities [ARIC] Study)

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