Abstract
AimsThe “early repolarization” (ER) pattern and J wave are frequent findings on standard ECG. Controversial data have recently been reported about their prognostic implications in healthy subjects, but no longitudinal prospective study specifically designed to investigate their long-term prognostic value has hitherto been published.Methods and ResultsWe prospectively enrolled 4,176 consecutive subjects with no evidence of cardiovascular disease who were referred for standard ECG recording for routine check-ups or pre-operative assessments for non-cardiovascular surgery. ECGs were prospectively assessed for the presence of ER/J wave. A 10-year follow-up was available for 3,937 patients (94.3%), 660 of whom (16.8%) showed ER/J wave whereas 3,277 did not. A total of 644 deaths occurred (16.3%), 116 (2.95%) of which were attributed to cardiovascular causes. Both total and cardiovascular mortality adjusted for clinical and laboratory variables did not differ significantly between patients with vs. without ER/J wave (HR 0.94; 95% CI 0.75–1.19; p = 0.63 and HR 0.61; 95% CI 0.31–1.21; p = 0.16, respectively). No significant association with total and cardiovascular mortality was also found in pre-specified analyses for ER and J wave alone, ER/J wave detected in specific ECG regions (i.e., inferior, lateral, precordial), and type of J wave (notched or slurred).ConclusionIn this specifically designed prospective study of individuals without any evidence of cardiovascular disease, we found no significant association of ER/J wave with the risk of the total as well as cardiovascular mortality during long-term follow-up.
Highlights
The pattern of “early repolarization” at the ECG has for a long time been considered a benign finding [1,2,3,4]
Previous population studies were not designed to prospectively investigate the prognostic role of early repolarization (ER)/J wave, but they were rather based on a retrospective assessment of ECGs of subjects included in institutional databases or enrolled in studies planned with other objectives
Among 4,176 subjects included in the study, 687 (16.5%) had evidence of ER/J wave
Summary
The pattern of “early repolarization” at the ECG has for a long time been considered a benign finding [1,2,3,4]. A few years ago, some case-control studies and, subsequently, some population studies reported a significant association of early repolarization (ER) with an increased risk of sudden death [5,6,7,8,9,10,11], as well as cardiovascular and total mortality [9, 12,13,14,15], raising clinical and medico-legal concerns among cardiologists [16, 17]. Repolarization and Clinical Outcome with ER/J wave [19,20,21,22,23,24] These controversial results have left the question of the risk associated with the ER/J wave in the population unresolved. The definition of ER, J point, and J wave varied among studies
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