Association of isolated minor nonspecific ST-T abnormalities with left ventricular hypertrophy and diastolic dysfunction

Jeong Gyu Kang,Hocheol Shin,Jang-Young Kim,Seungho Ryu,Yoosoo Chang,Ki-Chul Sung

doi:10.1038/s41598-018-27028-6

Abstract

The aim of this study was to examine the associations of isolated minor nonspecific ST-T abnormalities (NSSTTA) on 12-lead electrocardiogram (ECG) with left ventricular (LV) diastolic function and LV geometry on echocardiography. A cross-sectional study comprised of 74,976 Koreans who underwent ECG and echocardiography as part of a comprehensive health examination between March 2011 and December 2014. ECG was coded using Minnesota Code criteria. The frequencies of NSSTTA, impaired LV relaxation, and echocardiographic LVH were 1,139 (1.5%), 21,118 (28.2%), and 1,687 (2.3%) patients, respectively. The presence of NSSTTA was positively associated with the prevalence of impaired LV relaxation and LVH on echocardiography. In a multivariable-adjusted model, the odds ratio (95% CIs) comparing patients with NSSTTA to control patients was 1.55 (1.33–1.80) for impaired LV relaxation and 3.15 (2.51–3.96) for echocardiographic LVH. The association between NSSTTA and impaired LV relaxation was stronger in the intermediate to high cardiovascular disease-risk group than in the low-risk group according to Framingham Risk Score stratification (P for interaction = 0.02). NSSTTA were associated with increased prevalence of impaired LV relaxation and LVH, suggesting NSSTTA as an early indicator of subclinical cardiac dysfunction and geometric abnormalities.

Highlights

Heart failure is a progressive disease associated with aging, and up to half of heart failure cases are attributed to diastolic dysfunction[1]
We excluded 11,741 participants for the following reasons: missing data on either ECG, levels of serum glucose, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), or triglycerides, body mass index (BMI), or systolic blood pressure (BP) (n = 393); a history of malignancy (n = 2176); a history of cardiovascular disease (CVD) (n = 1085); decreased left ventricular (LV) systolic function, hypertrophic, dilated and ischemic cardiomyopathy, mitral/aortic stenosis of mild grade or greater, moderate or higher grade of mitral/aortic regurgitation, or post-operative cardiac surgery including valve replacement (n = 3213); or the presence of major ECG abnormalities according to the Minnesota Code (n = 4874)
Systolic and diastolic BP, and levels of fasting glucose, total cholesterol, LDL-C, and HDL-C were higher in the nonspecific ST-T wave abnormalities (NSSTTA) group

Summary

Introduction

Heart failure is a progressive disease associated with aging, and up to half of heart failure cases are attributed to diastolic dysfunction[1]. It is important to identify impaired LV relaxation and LVH in asymptomatic individuals for establishing preventive strategies before adverse cardiovascular events occur. ECG can reveal past heart events and predict future cardiovascular disease (CVD). Isolated minor nonspecific ST-T wave abnormalities (NSSTTA), one of the most common ECG abnormalities, are considered a benign finding in asymptomatic individuals, but several studies have found that NSSTTA are associated with increased risk of cardiovascular events or death[5,6,7]. The goal of this study was to examine the associations between NSSTTA and echocardiographic findings, including geometric changes and LV functional status, in a large sample of Korean men and women who participated in a health check-up program

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Discussion

Conclusion