Resting electrocardiogram predicts mortality in postmenopausal women with coronary heart disease or with risk factors for coronary heart disease

Abstract

Background:

Information about prognostic utility is limited for numerous electrocardiogram (ECG) abnormalities and is particularly scarce in women with coronary heart disease (CHD) or at increased risk of CHD occurrence.

Design:

This study used a prospectively planned observational post-hoc analysis of a negative randomised trial designed for other purposes.

Methods:

ECGs of 9789 postmenopausal women were analysed at a core laboratory. ECG abnormalities were determined and evaluated for mortality risk on top of established clinical risk factors and simultaneously with all other ECG abnormalities.

Results:

During a median follow-up of 5.6 years, 500 women sustained coronary death. Normal versus abnormal baseline ECGs were associated with an annual rate of 0.53% versus 1.28% coronary deaths. Ten clinically common ECG abnormalities, including left atrial abnormality, fragmented QRS, and Cornell voltage-only left ventricular hypertrophy, emerged as independent significant predictors of coronary death, eight of them also predicted all-cause mortality. Each ECG abnormality acted as a risk multiplier for a coexisting ECG abnormality. Two or three of any of the ECG abnormalities simultaneously present on the baseline ECG identified subsets with hazard ratios for coronary death of 3.3 or 5.5 respectively. Consideration of ECG abnormalities significantly improved risk stratification by common clinical parameters.

Conclusion:

The presence of ECG abnormalities provides independent risk information over and above that of established risk factors, both for women with CHD or at increased risk of occurrence of CHD. Normal ECG assures a low mortality risk regardless of whether CHD exists or not. The data derived could be applied to corresponding postmenopausal women in daily clinical practice.

Keywords

ECG abnormalities prognosis coronary heart disease postmenopausal women risk prediction

Get full access to this article

View all access options for this article.

References

Rautaharju

Kooperberg

Larson

. Electrocardiographic abnormalities that predict coronary heart disease events and mortality in postmenopausal women. The Women's Health Initiative. Circulation 2006; 113: 473–480.

Denes

Larson

Lloyd-Jones

. Major and minor ECG abnormalities in asymptomatic women and risk of cardiovascular events and mortality. JAMA 2007; 297: 978–985.

Barrett-Connor

Mosca

Collins

. for the Raloxifene Use for The Heart (RUTH) Trial Investigators. Effects of Raloxifene on cardiovascular events and breast cancer in postmenopausal women. N Engl J Med 2006; 355: 125–137.

Mosca

Barrett-Connor

Wenger

. Design and methods of the Raloxifene Use for The Heart (RUTH) study. Am J Cardiol 2001; 88: 392–395.

Casale

Devereux

Alonso

. Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings. Circulation 1987; 75: 565–572.

Morris

Estes

Whalen

. P-wave analysis in valvular heart disease. Circulation 1964; 29: 242–252.

Alpman

Güldal

Berkalp

. Importance of notching and slurring of the resting QRS complex in the diagnosis of coronary artery disease. J Electrocardiol 1995; 28: 199–208.

Heagerty

Zheng

. Survival model predictive accuracy and ROC curves. Biometrics 2005; 61: 92–105.

Pencina

D'Agostino Sr

Steyerberg

. Extensions of net reclassification improvement calculations to measure usefulness of new biomarkers. Statist Med 2011; 30: 11–21.

10.

Wannamethee

Welsh

Lowe

. N-terminal pro-brain natriuretic peptide is a more useful predictor of cardiovascular disease risk than C-reactive protein in older men with and without pre-existing cardiovascular disease. J Am Coll Cardiol 2011; 58: 56–64.

11.

Hlatky

Greenland

Arnett

. Criteria for evaluation of novel markers of cardiovascular risk: A scientific statement from the American Heart Association. Circulation 2009; 119: 2408–2416.

12.

Möhlenkamp

Lehmann

Moebus

. on behalf of the Heinz Nixdorf Recall Study Investigators. Quantification of coronary atherosclerosis and inflammation to predict coronary events and all-cause mortality. J Am Coll Cardiol 2011; 57: 1455–1464.

13.

Elias-Smale

Wieberdink

Odink

. Burden of atherosclerosis improves the prediction of coronary heart disease but not cerebrovascular events: The Rotterdam Study. Eur Heart J 2011; 32: 2050–2058.

14.

Wang

Lagakos

Ware

. Statistics in medicine – reporting of subgroup analyses in clinical trials. New Engl J Med 2007; 357: 2189–2194.

15.

De Bakker

JMT

van Capelle

FJL

Janse

. Fractionated electrograms in dilated cardiomyopathy: Origin and relation to abnormal conduction. J Am Coll Cardiol 1996; 27: 1071–1078.

16.

Morita

Kusano

Miura

. Fragmented QRS as a marker of conduction abnormality and a predictor of prognosis of Brugada Syndrome. Circulation 2008; 118: 1697–1704.

17.

Larssen

Blackburn

Scharling

. Prevelance and prognosis of electrocardiographic left ventricular hypertrophy, ST-segment depression and negative T-wave. The Copenhagen City Heart Study. Eur Heart J 2002; 23: 315–324.

18.

Bikkina

Larson

Levy

. Prognostic implications of asymptomatic ventricular arrhythmias: The Framingham Heart Study. Ann Intern Med 1992; 117: 990–996.

19.

Sajadieh

Nielsen

Rasmussen

. Ventricular arrhythmias and risk of death and acute myocardial infarction in apparently healthy subjects of age ≥55 years. Am J Cardiol 2006; 97: 1351–1357.

20.

Krobot

Wagner

Siebert

. Risk factor levels, risk factor combinations, and residual coronary risk: population-based estimates for secondary prevention patients using statins. Eur J Prev Cardiol 2012; 19: 109–117.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.30 MB