Prognostic value of automatically detected early repolarization

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Early repolarization associated with sudden cardiac death is based on the presence of >1-mm J-point elevations in inferior and/or lateral leads with horizontal and/or downsloping ST segments. Automated electrocardiographic readings of early repolarization (AER) obtained in clinical practice, in contrast, are defined by ST-segment elevation in addition to J-point elevation. Nonetheless, such automated readings may cause alarm. We therefore assessed the prevalence and prognostic significance of AER in 211,920 patients aged 18 to 75 years. The study was performed at a tertiary medical center serving a racially diverse urban population with a large proportion of Hispanics (43%). The first recorded electrocardiogram of each individual from 2000 to 2012 was included. Patients with ventricular paced rhythm or acute coronary syndrome at the time of acquisition were excluded from the analysis. All automated electrocardiographic interpretations were reviewed for accuracy by a board-certified cardiologist. The primary end point was death during a median follow-up of 8.0 ± 2.6 years. AER was present in 3,450 subjects (1.6%). The prevalence varied significantly with race (African-Americans 2.2%, Hispanics 1.5%, and non-Hispanic whites 0.9%, p <0.01) and gender (male 2.4% vs female 0.6%, p <0.001). In a Cox proportional hazards model controlling for age, smoking status, heart rate, QTc, systolic blood pressure, low-density lipoprotein cholesterol, body mass index, and coronary artery disease, there was no significant difference in mortality regardless of race or gender (relative risk 0.98, 95% confidence interval 0.89 to 1.07). This was true even if J waves were present. In conclusion, AER was not associated with an increased risk of death, regardless of race or gender, and should not trigger additional diagnostic testing.

Original languageEnglish (US)
Pages (from-to)1431-1436
Number of pages6
JournalAmerican Journal of Cardiology
Volume114
Issue number9
DOIs
StatePublished - Nov 1 2014

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Hispanic Americans
Reading
Blood Pressure
Urban Population
Sudden Cardiac Death
Acute Coronary Syndrome
Proportional Hazards Models
African Americans
LDL Cholesterol
Coronary Artery Disease
Electrocardiography
Body Mass Index
Heart Rate
Smoking
Confidence Intervals
Mortality
Cardiologists

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Prognostic value of automatically detected early repolarization. / Aagaard, Philip; Shulman, Eric; Di Biase, Luigi; Fisher, John Devens; Gross, Jay N.; Kargoli, Faraj; Kim, Soo G.; Palma, Eugen C.; Ferrick, Kevin J.; Krumerman, Andrew K.

In: American Journal of Cardiology, Vol. 114, No. 9, 01.11.2014, p. 1431-1436.

Research output: Contribution to journalArticle

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abstract = "Early repolarization associated with sudden cardiac death is based on the presence of >1-mm J-point elevations in inferior and/or lateral leads with horizontal and/or downsloping ST segments. Automated electrocardiographic readings of early repolarization (AER) obtained in clinical practice, in contrast, are defined by ST-segment elevation in addition to J-point elevation. Nonetheless, such automated readings may cause alarm. We therefore assessed the prevalence and prognostic significance of AER in 211,920 patients aged 18 to 75 years. The study was performed at a tertiary medical center serving a racially diverse urban population with a large proportion of Hispanics (43{\%}). The first recorded electrocardiogram of each individual from 2000 to 2012 was included. Patients with ventricular paced rhythm or acute coronary syndrome at the time of acquisition were excluded from the analysis. All automated electrocardiographic interpretations were reviewed for accuracy by a board-certified cardiologist. The primary end point was death during a median follow-up of 8.0 ± 2.6 years. AER was present in 3,450 subjects (1.6{\%}). The prevalence varied significantly with race (African-Americans 2.2{\%}, Hispanics 1.5{\%}, and non-Hispanic whites 0.9{\%}, p <0.01) and gender (male 2.4{\%} vs female 0.6{\%}, p <0.001). In a Cox proportional hazards model controlling for age, smoking status, heart rate, QTc, systolic blood pressure, low-density lipoprotein cholesterol, body mass index, and coronary artery disease, there was no significant difference in mortality regardless of race or gender (relative risk 0.98, 95{\%} confidence interval 0.89 to 1.07). This was true even if J waves were present. In conclusion, AER was not associated with an increased risk of death, regardless of race or gender, and should not trigger additional diagnostic testing.",
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