T-wave inversion on electrocardiogram is related to the risk of acute coronary syndrome in the general population

Bakhoya, Victor N; Kurl, Sudhir; Laukkanen, Jari A.

doi:10.1177/2047487312460022

Cited by 13 publications

(12 citation statements)

References 26 publications

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“…Several reports from different populations have shown that ECG abnormalities reflect increased risk of CVD . Thus, our finding of higher occurrence of new ECG abnormalities in patients with T1D highlights the increased risk of CVD in this population as they age.…”

Section: Discussionsupporting

confidence: 68%

“…Several reports from different populations have shown that ECG abnormalities reflect increased risk of CVD. [2][3][4][5][6][7][8][9][10][11][12][13] Thus, our finding of higher occurrence of new ECG abnormalities in patients with T1D highlights the increased risk of CVD in this population as they age. Notably, the reported prevalence of ECG abnormalities in the general population using the same ECG classification system range from 16% to 32%, [22][23][24][25][26] which is lower than rates observed in our study population of T1D.…”

Section: Discussionmentioning

confidence: 93%

“…However, our approach of using global classification ECG abnormalities is common, and several previous reports have shown its usefulness for both assessment and prediction of CVD. [2][3][4][5][6][7][8][9][10][11][12][13] The main reason for us and for previous reports for using global classification of ECG abnormalities is the lack of enough power to use ECG abnormalities individually in such type of analyses.…”

Section: Discussionmentioning

confidence: 99%

“…The resting 12‐lead electrocardiogram (ECG) is the most accessible test for screening and detection of cardiovascular disease (CVD) . In addition to its role in assessment of prevalent CVD, ECG abnormalities have also been used to predict poor outcomes in different populations …”

Section: Introductionmentioning

confidence: 99%

“…1 In addition to its role in assessment of prevalent CVD, ECG abnormalities have also been used to predict poor outcomes in different populations. [2][3][4][5][6][7][8][9][10][11][12][13] Patients with type 1 diabetes (T1D) are at a higher risk of CVD compared with age-matched individuals without diabetes. [14][15][16] Understanding the determinants and risk factors for developing new ECG abnormalities in T1D could facilitate better understanding of CVD in this high-risk population and identify those who may benefit from closer follow-up and aggressive risk factor management.…”

mentioning

confidence: 99%

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Progression of Electrocardiographic Abnormalities in Type 1 Diabetes During 16 Years of Follow‐up: The Epidemiology of Diabetes Interventions and Complications (EDIC) Study

Soliman

Backlund

Bebu

et al. 2016

JAHA

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BackgroundThe electrocardiogram (ECG) is an objective tool for cardiovascular disease (CVD) risk assessment.Methods and ResultsWe evaluated distribution of ECG abnormalities and risk factors for developing new abnormalities in 1314 patients with type 1 diabetes (T1D) from the Epidemiology of Diabetes Interventions and Complications (EDIC) study. Annual ECGs were centrally read. ECG abnormalities were classified as major and minor according to the Minnesota ECG Classification. At EDIC year 1 (baseline), 356 (27.1%) of the participants had at least 1 ECG abnormality (major or minor) whereas 26 (2%) had at least one major abnormality. During 16 years of follow‐up, 1016 (77.3%) participants developed at least 1 new ECG abnormality (major or minor), whereas 172 (13.1%) developed at least 1 new major abnormality. Independent risk factors for developing new major ECG abnormalities were: age, current smoking, increased systolic blood pressure, and higher glycosylated hemoglobin (hazard ratio [HR] [95% CI]: 1.04 [1.02–1.06] per 1‐year increase, 1.75 [1.22–2.53], 1.03 [1.01–1.05] per 1 mm Hg increase, and 1.16 [1.04–1.29] per 10% increase, respectively). Independent risk factors for developing any new ECG abnormalities (major or minor) were age and systolic blood pressure (HR [95% CI]: 1.02 [1.01–1.03] per 1‐year increase and 1.01 [1.00–1.02] per 1 mm Hg increase, respectively).ConclusionsNew ECG abnormalities commonly occur in the course of T1D, consistent with the recognized increasing risk for CVD as patients age. Advanced age, increased systolic blood pressure, smoking, and higher HbA1c are independent risk factor for developing major ECG abnormalities, which underscores the importance of tight glucose control in T1D in addition to management of common CVD risk factors.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Progression of Electrocardiographic Abnormalities in Type 1 Diabetes During 16 Years of Follow‐up: The Epidemiology of Diabetes Interventions and Complications (EDIC) Study

Soliman

Backlund

Bebu

et al. 2016

JAHA

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Long COVID in Uganda: Electrographic findings among patients at risk

Semulimi

Batte

Iraguha³

et al. 2023

Public Health Challenges

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Background: COVID-19 has a significant cardiovascular involvement. An electrocardiographic (ECG) abnormalities among people at a risk of Long COVID in Uganda was investigated. Methods: A cross-sectional study was conducted from February to June 2022 at the post COVID-19 clinic in Mulago National Specialized Hospital, Kampala. A standard resting ECG was performed on individuals at least 2 months following acute COVID-19, with a negative SARS-CoV-2 reverse-transcription polymerase chain reaction. Socio-demographic and clinical characteristics as well as vital signs were recorded for all study participants. Results: Of the 244 study participants, 117 (47.9%) were female. The median age of all the participants was 33.0 (interquartile range: 26.0-43.5) years. Twenty-five (10.2%) participants had a history of smoking, whereas 117 (48%) had a history of alcohol intake. In total, 46 (18.9%) had abnormal ECG findings (95% Confidence Interval [CI]: 14.39-24.29), and nonspecific T-wave inversion (n = 16, 34%) was the most frequent ECG abnormality. The proportion of participants with ECG abnormalities was 48% lower among females (adjusted prevalence ratio [aPR]: 0.52, 95% CI: 0.28-0.96, p value <0.05) and twofold greater for those with a history of smoking (aPR: 2.03, 95% CI: 1.096-3.776, p value <0.05). Conclusion: One in five Ugandans who were checked at the clinic at a risk of Long COVID showed ECG abnormalities. ECG screening is suggested to be integrated into the follow-up care of those at a risk of Long COVID.

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Association of T-wave abnormalities with major cardiovascular events in diabetes: the ACCORD trial

et al. 2021

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Aims/hypothesis T-wave abnormalities (TWA) are often found on ECG and signify abnormal ventricular repolarisation. While TWA have been shown to be associated with subclinical atherosclerosis, the relationship between TWA and hard cardiovascular endpoints is less clear and may differ in the presence of diabetes, so we sought to explore these associations in participants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Methods TWA were operationally defined as the presence of any Minnesota Codes 5-1 through 5-4 in any lead distribution. Multivariable Cox proportional hazards models were constructed to examine relationships between TWA and clinical cardiovascular events. Secondary analyses explored the risks conferred by major vs minor TWA, differential effects of TWA by anatomic localisation (anterolateral, inferior or anterior lead distributions), and differing associations in those with or without prevalent CVD. Results Among 8176 eligible participants (mean 62.1 ± 6.3 SD years, 61.4% male), there were 3759 cardiovascular events, including 1430 deaths (473 of a cardiovascular aetiology), 474 heart failure events, 1452 major CHD events and 403 strokes. Participants with TWA had increased risks of all-cause mortality (HR 1.45 [95% CI 1.30, 1.62], p < 0.0001), cardiovascular mortality (HR 1.93 [1.59, 2.34], p = 0.0001), congestive heart failure (HR 2.04 [1.69, 2.48], p < 0.0001) and major CHD (HR 1.40 [1.26, 1.57], p < 0.0001), but no increased risk of stroke (HR 0.99 [0.80, 1.23], p = 0.95). Major TWA conferred a higher risk than minor TWA. When TWA were added to the UK Prospective Diabetes Study risk engine, there was improved discrimination for incident CHD events, but only for those with prevalent CVD (area under the receiver operating characteristic curve 0.5744 and 0.6030 with p = 0.0067). Adding TWA to the risk engine yielded improvements in reclassification that were of greater magnitude in those with prevalent CVD (net reclassification improvement [NRI] 0.24 [95% CI 0.16, 0.32] in those with prevalent CVD, NRI 0.14 [95% CI 0.07, 0.22] in those without prevalent CVD). Conclusions/interpretation The presence and magnitude of TWA are associated with increased risk of clinical cardiovascular events and mortality in individuals with diabetes and may have value in refining risk, particularly in those with prevalent CVD.

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T-wave inversion on electrocardiogram is related to the risk of acute coronary syndrome in the general population

Abstract: TWI has a strong and independent predictive value for ACS in the general population.

Cited by 13 publications

References 26 publications

Progression of Electrocardiographic Abnormalities in Type 1 Diabetes During 16 Years of Follow‐up: The Epidemiology of Diabetes Interventions and Complications (EDIC) Study

Progression of Electrocardiographic Abnormalities in Type 1 Diabetes During 16 Years of Follow‐up: The Epidemiology of Diabetes Interventions and Complications (EDIC) Study

Long COVID in Uganda: Electrographic findings among patients at risk

Association of T-wave abnormalities with major cardiovascular events in diabetes: the ACCORD trial

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