Relation of poor R-wave progression to risk of cardiovascular mortality

Abstract

Purpose: Loss of anterior forces (R waves) may signify prior anterior myocardial infarction. We examined the prevalence and prognostic impact of poor R-wave progression (PRWP) in a standard electrocardiogram (ECG) in a general population. Methods: The Health 2000 survey is prospective and nationally representative population cohort (random sample) health examination survey conducted in Finland in 2000–2001. The final study population consisted of 5613 individuals with extensive clinical data, including resting ECG. Results: The prevalence of PRWP (defined as RV3 ≤3 mm and RV2 ≤ RV3) was 7.0% in women and 2.7% in men (P<0.001 for difference). During follow-up of 70±9 months (mean ± SD), 317 patients died (5.6%). Men and women with PRWP were older, had more diabetes, CHD, and previous MIs, than did those without PRWP, while for hypertension there was a difference between the groups that only concerned females. Both all-cause and cardiovascular mortality was higher in the group with PRWP than in those without PRWP in both women and men. In Cox regression analysis after adjustment for age, hypertension, diabetes, previous myocardial infarction, and coronary heart disease, the relative risk for all-cause mortality for PRWP was 1.69 (95% CI 0.89–3.22, P=0.112) for men and 2.00 (95% CI 1.28–3.13, P<0.002) for women. For cardiovascular mortality the relative risk for individuals with PRWP was 1.85 (0.74–4.65, P=0.19) for men and 3.02 (1.54–5.93, P<0.001) for women.When also subjects with inferior and anterior Q-waves were included in the analysis, PRWP independently predicted all-cause and cardiovascular mortality in both women and men. Conclusions: PRWP is a common ECG finding and predicts risk for total and cardiovascular mortality in women in a general population.