The Association and Predictive Ability of ECG Abnormalities with Cardiovascular Diseases: A Prospective Analysis.

Jingya Niu,Jieli Lu,Tiange Wang,Zhiyun Zhao,Guang Ning,Yu Xu,Mian Li,Ruizhi Zheng,Meng Dai,Yuhong Chen,Weiqing Wang,Shuangyuan Wang,Yufang Bi,Min Xu,Chanjuan Deng

doi:10.5334/gh.790

Abstract

Aims:To examine whether electrocardiography (ECG) could provide additional values to the traditional risk factors for cardiovascular disease (CVD) risk prediction among different cardiovascular risk subgroups.Methods:A total of 7,872 community residents aged ≥40 years were followed up for a median of 4.5 years. A 12-lead resting ECG was examined for participants at baseline. CVD events including myocardial infarction, stroke and cardiovascular mortality were collected. Cox proportional hazards models were used and models of traditional risk factors with and without ECG were compared.Results:At baseline, 2,470 participants (31.3%) had ECG abnormalities. During follow-up, 464 participants developed CVD events. ECG abnormalities were associated with an increased risk of CVD after adjustment for the traditional risk factors in participants with a 10-year atherosclerotic CVD (ASCVD) risk ≥10% (hazard ratio, HR: 1.45; 95% confidence interval, CI: 1.11, 1.91). Adding ECG abnormalities to the traditional CVD risk factors improved reclassification for those who did not experience events [net reclassification index: 8.0% (95% CI: 2%, 19.5%)], discrimination (integrated discrimination improvement: 0.7% (95% CI: 0.1%, 1.9%), and calibration (goodness of fit P value from 0.600 to 0.873) in participants with a 10-year ASCVD risk ≥10%. However, no significant association and improvement were found in participants with a 10-year ASCVD risk <10%.Conclusions:ECG screening might provide a marginal improvement in CVD risk prediction in adults at high risk. However, ECG should not be recommended in adults at low risk.

Highlights

Cardiovascular disease (CVD) is the most common cause of death worldwide and in China [1]
Using data from a well-defined community-based population cohort, we found that the resting ECG abnormalities were significantly and independently associated with an increased risk of developing CVD events and the addition of ECG abnormalities to the traditional CVD risk factors marginally improved the prediction of future CVD events in adults with a 10-year atherosclerotic CVD (ASCVD) risk ≥10%
The resting ECG abnormalities were not associated with an increased risk of developing CVD events and did not improve the prediction of future CVD events in adults with a 10-year ASCVD risk

Summary

Introduction

Cardiovascular disease (CVD) is the most common cause of death worldwide and in China [1]. Because many patients do not have a diagnosis or symptoms of CVD before the first clinical event, identifying high-risk and asymptomatic individuals for early prevention and timely intervention is of great importance [2, 3] Risk prediction tools such as the Framingham Risk Score and the Pooled Cohort Equations use traditional CVD risk factors including sex, age, smoking, blood pressure, lipids, and diabetes status to calculate the probabilities of developing CVD events in the following 10 years [4, 5]. Patients identified by these assessment tools as at high risk can benefit from preventive measures and improved risk assessments could lead to improved cardiovascular outcomes [6]. We used data from a community-based population cohort to assess the predictive ability of ECG for CVD events beyond traditional cardiovascular risk factors among asymptomatic Chinese adults aged ≥40 years and stratified on baseline cardiovascular risks

Patients and Methods

Results

Discussion

Funding Information