Early repolarization pattern in an ethnically diverse population: Increased risk in Hispanics

Ephraim Leiderman, Faraj Kargoli, Eric Shulman, Philip Aagaard, Ethan Hoch, Lynn Zaremski, Luigi Di Biase, Soo G. Kim, Jay N. Gross, Kevin J. Ferrick, John Fisher, Andrew Krumerman

Research output: Contribution to journalArticle

Abstract

Background: Early repolarization (ER) pattern on ECG is associated with an increased mortality in Caucasians. This study analyzed the association between ER pattern and all-cause mortality in a population of multiple ethnicities. Methods: A total of 20 000 individuals were randomly selected and their ECGs were analyzed for ER pattern using the 2015 consensus: end-QRS notching or slurring with a J-point (Jp) ≥0.1 mV in contiguous inferior or lateral leads. Exclusion criteria were age <18, QRS duration of ≥120 ms, and acute myocardial infarction. Kaplan-Meier survival curves were used to assess crude survival, and multivariable logistic regression models were used to determine predictors of all-cause mortality. Results: A total of 17 901 patients with a mean age of 53 met inclusion criteria. Individuals were 62% female, 14% White, 37% Black, 40% Hispanic, and 9% other. Median follow-up time was 6.4 years. ER pattern was noted in 995 (5.6%) patients. Jp ≥2 mm was noted in 282 (1.6%) patients. In those with ER pattern and Jp ≥1 mm, there was no difference in mortality when compared to individuals without Jp elevation (odds ratio [OR]: 0.962, 95% confidence of interval [CI]: 0.819-1.131). Patients with Jp ≥2 mm had a significantly increased all-cause mortality (OR: 1.333, 95% CI: 1.009-1.742). This increased mortality was also significant in Hispanic patients with Jp ≥2 mm (OR: 1.584, 95% CI: 1.003-2.502). Conclusion: ER pattern with Jp ≥2 mm is associated with increased mortality in a multiethnic population, apparently driven by an increased risk in Hispanics.

Original languageEnglish (US)
JournalPACE - Pacing and Clinical Electrophysiology
DOIs
StateAccepted/In press - Jan 1 2019

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Hispanic Americans
Mortality
Population
Odds Ratio
Confidence Intervals
Electrocardiography
Logistic Models
Kaplan-Meier Estimate
Myocardial Infarction
Survival

Keywords

  • early repolarization
  • ethnicity
  • Hispanic
  • J-point

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Leiderman, E., Kargoli, F., Shulman, E., Aagaard, P., Hoch, E., Zaremski, L., ... Krumerman, A. (Accepted/In press). Early repolarization pattern in an ethnically diverse population: Increased risk in Hispanics. PACE - Pacing and Clinical Electrophysiology. https://doi.org/10.1111/pace.13827

Early repolarization pattern in an ethnically diverse population : Increased risk in Hispanics. / Leiderman, Ephraim; Kargoli, Faraj; Shulman, Eric; Aagaard, Philip; Hoch, Ethan; Zaremski, Lynn; Di Biase, Luigi; Kim, Soo G.; Gross, Jay N.; Ferrick, Kevin J.; Fisher, John; Krumerman, Andrew.

In: PACE - Pacing and Clinical Electrophysiology, 01.01.2019.

Research output: Contribution to journalArticle

Leiderman, E, Kargoli, F, Shulman, E, Aagaard, P, Hoch, E, Zaremski, L, Di Biase, L, Kim, SG, Gross, JN, Ferrick, KJ, Fisher, J & Krumerman, A 2019, 'Early repolarization pattern in an ethnically diverse population: Increased risk in Hispanics', PACE - Pacing and Clinical Electrophysiology. https://doi.org/10.1111/pace.13827
Leiderman, Ephraim ; Kargoli, Faraj ; Shulman, Eric ; Aagaard, Philip ; Hoch, Ethan ; Zaremski, Lynn ; Di Biase, Luigi ; Kim, Soo G. ; Gross, Jay N. ; Ferrick, Kevin J. ; Fisher, John ; Krumerman, Andrew. / Early repolarization pattern in an ethnically diverse population : Increased risk in Hispanics. In: PACE - Pacing and Clinical Electrophysiology. 2019.
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abstract = "Background: Early repolarization (ER) pattern on ECG is associated with an increased mortality in Caucasians. This study analyzed the association between ER pattern and all-cause mortality in a population of multiple ethnicities. Methods: A total of 20 000 individuals were randomly selected and their ECGs were analyzed for ER pattern using the 2015 consensus: end-QRS notching or slurring with a J-point (Jp) ≥0.1 mV in contiguous inferior or lateral leads. Exclusion criteria were age <18, QRS duration of ≥120 ms, and acute myocardial infarction. Kaplan-Meier survival curves were used to assess crude survival, and multivariable logistic regression models were used to determine predictors of all-cause mortality. Results: A total of 17 901 patients with a mean age of 53 met inclusion criteria. Individuals were 62{\%} female, 14{\%} White, 37{\%} Black, 40{\%} Hispanic, and 9{\%} other. Median follow-up time was 6.4 years. ER pattern was noted in 995 (5.6{\%}) patients. Jp ≥2 mm was noted in 282 (1.6{\%}) patients. In those with ER pattern and Jp ≥1 mm, there was no difference in mortality when compared to individuals without Jp elevation (odds ratio [OR]: 0.962, 95{\%} confidence of interval [CI]: 0.819-1.131). Patients with Jp ≥2 mm had a significantly increased all-cause mortality (OR: 1.333, 95{\%} CI: 1.009-1.742). This increased mortality was also significant in Hispanic patients with Jp ≥2 mm (OR: 1.584, 95{\%} CI: 1.003-2.502). Conclusion: ER pattern with Jp ≥2 mm is associated with increased mortality in a multiethnic population, apparently driven by an increased risk in Hispanics.",
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T2 - Increased risk in Hispanics

AU - Leiderman, Ephraim

AU - Kargoli, Faraj

AU - Shulman, Eric

AU - Aagaard, Philip

AU - Hoch, Ethan

AU - Zaremski, Lynn

AU - Di Biase, Luigi

AU - Kim, Soo G.

AU - Gross, Jay N.

AU - Ferrick, Kevin J.

AU - Fisher, John

AU - Krumerman, Andrew

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N2 - Background: Early repolarization (ER) pattern on ECG is associated with an increased mortality in Caucasians. This study analyzed the association between ER pattern and all-cause mortality in a population of multiple ethnicities. Methods: A total of 20 000 individuals were randomly selected and their ECGs were analyzed for ER pattern using the 2015 consensus: end-QRS notching or slurring with a J-point (Jp) ≥0.1 mV in contiguous inferior or lateral leads. Exclusion criteria were age <18, QRS duration of ≥120 ms, and acute myocardial infarction. Kaplan-Meier survival curves were used to assess crude survival, and multivariable logistic regression models were used to determine predictors of all-cause mortality. Results: A total of 17 901 patients with a mean age of 53 met inclusion criteria. Individuals were 62% female, 14% White, 37% Black, 40% Hispanic, and 9% other. Median follow-up time was 6.4 years. ER pattern was noted in 995 (5.6%) patients. Jp ≥2 mm was noted in 282 (1.6%) patients. In those with ER pattern and Jp ≥1 mm, there was no difference in mortality when compared to individuals without Jp elevation (odds ratio [OR]: 0.962, 95% confidence of interval [CI]: 0.819-1.131). Patients with Jp ≥2 mm had a significantly increased all-cause mortality (OR: 1.333, 95% CI: 1.009-1.742). This increased mortality was also significant in Hispanic patients with Jp ≥2 mm (OR: 1.584, 95% CI: 1.003-2.502). Conclusion: ER pattern with Jp ≥2 mm is associated with increased mortality in a multiethnic population, apparently driven by an increased risk in Hispanics.

AB - Background: Early repolarization (ER) pattern on ECG is associated with an increased mortality in Caucasians. This study analyzed the association between ER pattern and all-cause mortality in a population of multiple ethnicities. Methods: A total of 20 000 individuals were randomly selected and their ECGs were analyzed for ER pattern using the 2015 consensus: end-QRS notching or slurring with a J-point (Jp) ≥0.1 mV in contiguous inferior or lateral leads. Exclusion criteria were age <18, QRS duration of ≥120 ms, and acute myocardial infarction. Kaplan-Meier survival curves were used to assess crude survival, and multivariable logistic regression models were used to determine predictors of all-cause mortality. Results: A total of 17 901 patients with a mean age of 53 met inclusion criteria. Individuals were 62% female, 14% White, 37% Black, 40% Hispanic, and 9% other. Median follow-up time was 6.4 years. ER pattern was noted in 995 (5.6%) patients. Jp ≥2 mm was noted in 282 (1.6%) patients. In those with ER pattern and Jp ≥1 mm, there was no difference in mortality when compared to individuals without Jp elevation (odds ratio [OR]: 0.962, 95% confidence of interval [CI]: 0.819-1.131). Patients with Jp ≥2 mm had a significantly increased all-cause mortality (OR: 1.333, 95% CI: 1.009-1.742). This increased mortality was also significant in Hispanic patients with Jp ≥2 mm (OR: 1.584, 95% CI: 1.003-2.502). Conclusion: ER pattern with Jp ≥2 mm is associated with increased mortality in a multiethnic population, apparently driven by an increased risk in Hispanics.

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KW - Hispanic

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