Abstract
Poor R-wave progression (PRWP) is a common clinical finding on the standard 12-lead electrocardiogram (ECG), but its prognostic significance is unclear. The purpose of this study was to examine the prognosis associated with PRWP in terms of sudden cardiac death (SCD), cardiac death, and all-cause mortality in general population subjects with and without coronary artery disease (CAD). Data and 12-lead ECGs were collected from a Finnish general population health examination survey conducted during 1978-1980 with follow-up until 2011. The study population consisted of 6854 subjects. Main end points were SCD, cardiac death, and all-cause mortality. PRWP was defined as R-wave amplitude ≤ 0.3 mV in lead V3 and R-wave amplitude in lead V2 ≤ R-wave amplitude in lead V3. PRWP occurred in 213 subjects (3.1%). During the follow-up period of 24.3 ± 10.4 years, 3723 subjects (54.3%) died. PRWP was associated with older age, higher prevalence of heart failure and CAD, and β-blocker medication. In multivariate analyses, PRWP was associated with SCD (hazard ratio [HR] 2.13; 95% confidence interval [CI] 1.34-3.39), cardiac death (HR 1.75; 95% CI 1.35-2.15), and all-cause mortality (HR 1.29; 95% CI 1.08-1.54). In the subgroup with CAD, PRWP had a stronger association with cardiac mortality (HR 1.71; 95% CI 1.19-2.46) than in the subgroup without CAD, while the association with SCD was significant only in the subgroup with CAD (HR 2.62; 95% CI 1.38-4.98). PRWP was associated with adverse prognosis in the general population and with SCD in subjects with CAD.
Highlights
Sudden cardiac death (SCD) is a major cause of death and in many cases the first manifestation of heart disease
In the subgroup with Coronary artery disease (CAD), Poor R-wave progression (PRWP) had a stronger association with cardiac mortality (HR 1.71; 95% confidence intervals (CIs) 1.19–2.46) than in the subgroup without CAD, while the association with SCD was significant only in the subgroup with CAD (HR 2.62; 95% CI 1.38–4.98)
PRWP was associated with adverse prognosis in the general population and with SCD in subjects with CAD
Summary
Sudden cardiac death (SCD) is a major cause of death and in many cases the first manifestation of heart disease. Coronary artery disease (CAD) is the most common underlying condition leading to SCD.[1] In the current treatment guidelines, the primary prevention of SCD with implantable was associated with older age, higher prevalence of heart failure and CAD, and b-blocker medication. 1.35–2.15), and all-cause mortality (HR 1.29; 95% CI 1.08–1.54). In the subgroup with CAD, PRWP had a stronger association with cardiac mortality (HR 1.71; 95% CI 1.19–2.46) than in the subgroup without CAD, while the association with SCD was significant only in the subgroup with CAD (HR 2.62; 95% CI 1.38–4.98). Poor R-wave progression (PRWP) is a common clinical finding in the standard 12-lead electrocardiogram (ECG), but its prognostic significance is unclear
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