TITLE

Electrocardiographic and clinical predictors separating atherosclerotic sudden cardiac death from incident coronary heart disease

AUTHOR(S)
Soliman, Elsayed Z.; Prineas, Ronald J.; Case, L. Douglas; Russell, Gregory; Rosamond, Wayne; Rea, Thomas; Sotoodehnia, Nona; Post, Wendy S.; Siscovick, David; Psaty, Bruce M.; Burke, Gregory L.
PUB. DATE
October 2011
SOURCE
Heart;Oct2011, Vol. 97 Issue 19, p1597
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Objective To identify specific ECG and clinical predictors that separate atherosclerotic sudden cardiac death (SCD) from incident coronary heart disease (CHD) (nonfatal events and non-sudden death) in the combined cohorts of the Atherosclerosis Risk in Communities study and the Cardiovascular Health Study. Methods This analysis included 18 497 participants (58% females, 24% black individuals, mean age 58 years) who were initially free of clinical CHD. A competing risk analysis was conducted to examine the prognostic significance of baseline clinical characteristics and an extensive electronic database of ECG measurements for prediction of 229 cases of SCD as a first event versus 2297 incident CHD cases (2122 non-fatal events and 175 non-sudden death) that occurred during a median follow-up time of 13 years in the Cardiovascular Health Study and 14 years in the Atherosclerosis Risk in Communities study. Results After adjusting for common CHD risk factors, a number of clinical characteristics and ECG measurements were independently predictive of SCD and CHD. However, the risk of SCD versus incident CHD was significantly different for race/ethnicity, hypertension, body mass index (BMI), heart rate, QTc, abnormally inverted T wave in any ECG lead group and level of ST elevation in V2. Black race/ethnicity (compared to non-black) was predictive of high SCD risk but less risk of incident CHD (p value for differences in the risk (HR) for SCD versus CHD <0.0001). Hypertension, increased heart rate, prolongation of QTc and abnormally inverted T wave were stronger predictors of high SCD risk compared to CHD (p value=0.0460, 0.0398, 0.0158 and 0.0265, respectively). BMI was not predictive of incident CHD but was predictive of high SCD risk in a quadratic fashion (p value=0.0220). On the other hand, elevated ST height as measured at the J point and that measured at 60 ms after the J point in V2 were not predictive of SCD but were predictive of high incident CHD risk (p value=0.0251 and 0.0155, respectively). Conclusions SCD and CHD have many risk factors in common. Hypertension, race/ethnicity, BMI, heart rate, QTc, abnormally inverted T wave in any ECG lead group and level of ST elevation in V2 have the potential to separate between the risks of SCD and CHD. These results need to be validated in another cohort.
ACCESSION #
66172636

 

Related Articles

  • Obesity related risk of sudden cardiac death in the atherosclerosis risk in communities study. Adabag, Selcuk; Huxley, Rachel R.; Lopez, Faye L.; Lin Y. Chen; Sotoodehnia, Nona; Siscovick, David; Deo, Rajat; Konety, Suma; Alonso, Alvaro; Folsom, Aaron R. // Heart;2/1/2015, Vol. 101 Issue 3, p215 

    Objective To examine the association of body mass index (BMI), waist circumference (WC) and waist hip ratio (WHR) with sudden cardiac death (SCD) in community dwelling individuals. Methods Data from a multicentre, prospective, cohort study of 14 941 men and women (African American, and white),...

  • Heart rate variability as a biomarker for autonomic nervous system response differences between children with chronic pain and healthy control children. Evans, Subhadra; Seidman, Laura C.; Tsao, Jennie CI.; Lung, Kirsten C.; Zeltzer, Lonnie K.; Naliboff, Bruce D. // Journal of Pain Research;2013, Vol. 6, p449 

    Studies in adults have demonstrated a relationship between lowered heart rate variability (HRV) and poor health. However, less is known about the role of autonomic arousal in children's well-being. The aim of the current study was to examine resting HRV in children with chronic pain compared to...

  • Relationship between Hbalc levels and the severity of coronary artery disease in diabetic patients. Ozlu, Mehmet Fatih; Ayhan, Suzi Selim; Ozturk, Serkan; Alcelik, Aytekin; Aktas, Gulali; Erdem, Kemalettin; Ozyasar, Mehmet; Yazıcı, Mehemt // Journal of Harran University Medical Faculty;2012, Vol. 9 Issue 1, p15 

    Background: Diabetes Mellitus (DM) is one of the most important risk factors for coronary artery disease (CAD). The hemoglobin A1c (HbA1c) is used for evaluating glycemic control in DM patients. It was shown in some studies that; HbA1 c levels may be related to cardiovascular risk and all cause...

  • Measuring Pulse Wave Velocity Using ECG and Photoplethysmography. Liu, An-Bang; Hsu, Po-Chun; Chen, Zong-Li; Wu, Hsien-Tsai // Journal of Medical Systems;Oct2011, Vol. 35 Issue 5, p771 

    Pulse wave velocity (PWV) is a useful method to assess arterial stiffness and predict mortality of atherosclerosis-related diseases. The progression of atherosclerosis is not homogeneous. There must be difference of PWV between sites by site. Therefore we designed a multi-channel instrument to...

  • El síndrome de QT largo: una breve revisión del diagnóstico electrocardiográfico incluyendo la prueba de Viskin. Márquez, Manlio F. // Archivos de Cardiología de México;jul-sep2012, Vol. 82 Issue 3, p243 

    The QT interval measures both repolarization and depolarization. Learning to measure the QT interval and know how to correct (QTc) for heart rate (HR) is essential for the diagnosis of long QT syndrome (LQTS). The QTc interval changes in duration and even morphology depending on the time of the...

  • True and true, but not a paradox. Stovitz, Steven D. // Heart;Nov2015, Vol. 101 Issue 22, p1850 

    A letter to the editor is presented regarding the articles published about meta-analysis and a commentary on the relation of mortality and obesity in patients with coronary heart disease (CHD).

  • Autonomic dysfunction of overweight combined with low muscle mass. Baek, Jihye; Park, Donghwan; Kim, Inah; Won, Jong-Uk; Hwang, Jungho; Roh, Jaehoon // Clinical Autonomic Research;Dec2013, Vol. 23 Issue 6, p325 

    Objective: To examine the relationship between overweight combined with low muscle mass and the cardiac autonomic nervous system using heart rate variability (HRV) in healthy workers. Methods: A total of 1,150 workers were included, with a mean age of 43.55 ± 11.45 years. The...

  • Neck Circumference and Early Stage Atherosclerosis: the Cardiometabolic Risk in Chinese (CRC) Study. Jun Liang; Yu Wang; Hongyan Li; Xuekui Liu; Qinqin Qiu; Lu Qi // Cardiovascular Diabetology;2014, Vol. 13 Issue 1, p1 

    Background Neck circumference (NC) has been previously related to cardiometabolic risk factors. In this study we examined the association between NC and early stage atherosclerosis in Chinese adults. Methods The study samples were from a community-based health examination survey in central...

  • Why Does the QRS Widen? Grauer, Ken // Internal Medicine Alert;6/15/2007, Vol. 29 Issue 11, p88 

    The article presents information on the QRS complex and the clinical implication of its widening in the setting of cardiac arrest.

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sign out of this library

Other Topics