Major Electrocardiogram Abnormalities Research Articles

PECGreview: Assessment of a Novel Tool to Evaluate the Accuracy of Pediatric ECG Interpretation Skills.

The skill of interpretation of the electrocardiogram (ECG) remains poor despite existing educational initiatives. We sought to evaluate the validity of using a subjective scoring system to assess the accuracy of ECG interpretations submitted by pediatric cardiology fellows, trainees, and faculty to the Pediatric ECG Review (pECGreview), a web-based ECG interpretation training program. We conducted a retrospective, cross-sectional study of responses submitted to pECGreview. ECG interpretations were assessed independently by four individuals with a range of experience. Accuracy was assessed using a 3-point scale: 100% for generally correct interpretations, 50% for over- or underdiagnosis of minor ECG abnormalities, and 0% for over- or underdiagnosis of major ECG abnormalities. Inter-rater agreement was assessed using expanded Bland-Altman plots, Pearson correlation coefficients, and Intraclass Correlation Coefficients (ICC). 1460 ECG interpretations by 192 participants were analyzed. 107 participants interpreted at least five ECGs. The mean accuracy score was 76.6 ± 13.7%. Participants were correct in 66.1 ± 5.1%, had minor over- or underdiagnosis in 21.5 ± 4.6% and major over- or underdiagnosis in 12.3 ± 3.9% of interpretations. Validation of agreement between evaluators demonstrated limits of agreement of 11.3%. Inter-rater agreement exhibited consistent patterns (all correlations ≥ 0.75). Absolute agreement was 0.74 (95% CI 0.69-0.80), and average measures agreement was 0.92 (95% CI 0.89-0.94). Accuracy score analysis of as few as five ECG interpretations submitted to pECGreview yielded good inter-rater reliability for assessing and ranking ECG interpretation skills in pediatric cardiology fellows in training.

Routine Electrocardiogram Screening and Cardiovascular Disease Events in Adults

ImportanceThe resting electrocardiogram (ECG) is commonly performed for cardiovascular disease (CVD) screening purposes in Japan. However, evidence is limited regarding the prognostic significance of ECG in clinical practice settings.ObjectiveTo investigate the association between ECG abnormalities and CVD outcomes in a working-age population.Design, Setting, and ParticipantsThis nationwide cohort study included individuals aged 35 to 65 years from the Japan Health Insurance Association database, which covers approximately 40% (30 million) of the working-age population in Japan. Data from April 1, 2015, to March 31, 2022, were included, and analysis was conducted from October 1, 2022, to April 11, 2024.ExposuresBaseline ECG status (normal, 1 minor abnormality, ≥2 minor abnormalities, or major abnormality).Main Outcomes and MeasuresThe primary outcome was a composite of overall death and CVD hospital admission due to myocardial infarction, stroke, or heart failure. The secondary outcome was developing a new major ECG abnormality over the years of screening.ResultsOf 3 698 429 individuals enrolled in the nationwide annual health check program (mean [SD] age, 47.1 [8.5] years; 66.6% male), 623 073 (16.8%) had 1 minor ECG abnormality, 144 535 (3.9%) had 2 or more minor ECG abnormalities, and 56 921 (1.5%) had a major ECG abnormality. During a median follow-up of 5.5 (IQR, 3.4-5.7) years, baseline ECG abnormality was independently associated with an increased incidence of the composite end points of overall death and CVD admission compared with normal ECG (incidence rates per 10 000 person-years: 92.7 [95% CI, 92.2-93.2] for normal ECG, 128.5 [95% CI, 127.2-129.9] for 1 minor ECG abnormality, 159.7 [95% CI, 156.6-162.9] for ≥2 minor ECG abnormalities, and 266.3 [95% CI, 259.9-272.3] for a major ECG abnormality; adjusted hazard ratios: 1.19 [95% CI, 1.18-1.20] for 1 minor ECG abnormality, 1.37 [95% CI, 1.34-1.39] for ≥2 minor ECG abnormalities, and 1.96 [95% CI, 1.92-2.02] for a major ECG abnormality). Furthermore, the presence and number of minor ECG abnormalities were associated with an increased incidence of developing new major ECG abnormalities (incidence rates per 10 000 person-years: 85.1 [95% CI, 84.5-85.5] for normal ECG, 217.2 [95% CI, 215.5-219.0] for 1 minor ECG abnormality, and 306.4 [95% CI, 302.1-310.7] for ≥2 minor ECG abnormalities; and adjusted hazard ratios: 2.52 [95% CI, 2.49-2.55] for 1 minor ECG abnormality and 3.61 [95% CI, 3.55-3.67] for ≥2 minor ECG abnormalities). Associations were noted regardless of baseline CVD risk.Conclusions and RelevanceThe findings of this study suggest that the potential role of routine ECG screening for early prevention of CVD events, along with the optimal follow-up strategy, should be examined in future studies.

#886 Prevalence and prognostic relevance of electrocardiographic abnormalities among patients with ANCA-associated vasculitis

Abstract Background and Aims Cardiovascular disease (CVD) is one of the leading causes of death in patients with ANCA-associated vasculitis (AAV). However, in current clinical guidelines, limited evidence is available to support the recommendation of AAV-specific screening for cardiovascular comorbidities. This study reported the prevalence of electrocardiogram (ECG) abnormalities and investigated associations between ECG abnormalities and fatal CVD in a validated cohort of patients with AAV compared to matched controls. Method Based on a retrospective matched cohort design, patients with granulomatosis with polyangiitis [ICD-10: DM31.3] or microscopic polyangiitis [ICD-10: DM3.17] and accessible ECGs were identified in nationwide Danish health care registers from 2000 to 2021. Patients with AAV were matched 1:3 on age, sex, and calendar year of ECG measurement with controls without AAV. Index date was defined as the date of ECG measurement. ECGs were hierarchically categorized as either no, minor, or major ECG abnormalities according to contemporary literature. The associations between ECG abnormalities and fatal CVD were assessed in multiple Cox regression models adjusted for age, sex, and comorbidities. Counterfactual G-estimation of hazard ratios (HRs) standardized to age and sex was performed to estimate the 5-year absolute risk (AR) of fatal CVD according to ECG-abnormalities. Results A total of 1431 patients with AAV were matched to 4293 controls. The median age of patients with AAV and matched controls was 69 (IQR 58-77) years, and 52.3% were males. Median study follow-up time was 4.8 (IQR, 2.7-7.8) years. AAV was associated with increased prevalence of left ventricular hypertrophy (17.5% vs. 12.5%, p < 0.001), ST-T deviations (10.1% vs. 7.1%, p < 0.001), atrial fibrillation (9.6% vs. 7.5%, p = 0.017) and corrected QT prolongation (5.9% vs. 3.6%, p < 0.001) compared to controls. When examining associations of fatal CVD across no, minor or major ECG abnormalities, only the patients with AAV and major ECG abnormalities had a higher risk of fatal CVD [HR 1.99 (95% CI, 1.49-2.65)], compared to matched controls. This corresponded to a significantly higher standardized 5-year AR of fatal CVD compared to controls: 19.14% (95% CI, 16-22%) vs. 9.41% (95% CI, 8-11%). Conclusion AAV was associated with a higher prevalence of major ECG abnormalities such as left ventricular hypertrophy, atrial fibrillation, and ST-T deviations compared to matched controls. Moreover, the patients with AAV demonstrating major ECG abnormalities had a particularly elevated risk of fatal CVD. This indicates that AAV patients with major ECG abnormalities are a distinct high-risk group within AAV patients prone to cardiovascular-related mortality.

Association of major and minor ECG abnormalities with traditional cardiovascular risk factors in the general population: a large scale study

Cardiovascular disease (CVD) can be determined and quantified using the electrocardiogram (ECG) analysis. Identification of the risk factors associated with ECG abnormalities may advise prevention approaches to decrease CVD burden. In this study we aimed to investigate the association between CVD risk factors and minor and major ECG abnormalities in a general Iranian adult population. This study was conducted in 2010 and covered a population of 9035 males and females aged 35 to 65 years recruiting from the phase I of Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) cohort study. The participants were drawn by a stratified cluster random sampling technique. The Bivariate and multinomial logistic regression analysis were conducted considering gender stratification to explore the association of ECG abnormalities with traditional cardiovascular risk factors. There was a significant association between minor and major ECG abnormalities and hypertension (HTN), type 2 diabetes (T2DM), smoking, and physical activity (p < 0.005). There was a significant trend, in both genders, for increasing major abnormalities as the number of CVD risk factors increased. But, only in women, the minor abnormalities increase in frequency as the number of CVD risk factors increased. The results of multinomial logistic regression showed that men with HTN [ARRR = 1.25, 95% CI 0.99, 1.57] and T2DM [ARRR = 1.31, 95% CI 0.99, 1.74] had the highest likelihood to have major abnormalities, although these are not statistically significant. For women, those with HTN had the highest likelihood to have major [ARRR = 1.36, 95% CI 1.13, 1.63] and minor [ARRR = 1.35, 95% CI 1.15, 1.58] abnormalities. Also, women aged > 60 years were more likely to have major [ARRR = 2.01, 95% CI 1.49, 2.74] and minor [ARRR = 1.59, 95% CI 1.20, 2.10] abnormalities compared to women aged < 45 years. Age and HTN were significantly associated with major and minor ECG abnormalities in women, and, on the other hand, HTN and T2DM were associated with major abnormalities in men. Taken together, these findings suggest that healthcare providers should advise preventive approaches to the asymptomatic adults with both major and minor electrocardiographic abnormalities that may predict cardiovascular risk.

Diagnostic accuracy of a smartphone application for artificial intelligence-based interpretation of 12-lead ECG in primary care (AMSTELHEART-1)

Abstract Background The use of 12-lead electrocardiogram (ECG) is common in routine primary care, however it can be difficult for less experienced ECG readers to adequately interpret the ECG. Objective To validate a novel smartphone application as a stand-alone interpretation tool for 12-lead ECG in primary care. Methods We recruited consecutive patients who underwent 12-lead ECG as part of routinely indicated primary care in the Netherlands. All ECGs were assessed by a smartphone application which analyses a photographed image of 12-lead ECG for automated interpretation, installed on an Android platform and an iOS platform. We validated the application for detecting: 1) any major ECG abnormality (MEA, primary outcome) defined as atrial fibrillation/flutter (AF), markers of (past) myocardial ischemia or clinically relevant impulse and/or conduction abnormalities; or 2) AF (key secondary outcome). The reference standard was a blinded expert panel. Results We included 290 patients from 11 Dutch general practices with median age 67 (IQR 55-74) years, 48% were female. On reference ECG, 71 patients (25%) had MEA, 35 (12%) had AF. The app's sensitivity and specificity for MEA were 86% (95%CI:76-93) and 92% (95%CI:87-95), respectively. For AF, sensitivity and specificity were 97% (95%CI:85-100) and 99% (95%CI:97-100), respectively. Performance was comparable between Android and iOS platform (Kappa=0.95, 95%CI:0.91-0.99 and Kappa=1.00, 95%CI:1.00-1.00 for MEA and AF, respectively). Conclusions A smartphone application that interprets photographed 12-lead ECG images had good diagnostic accuracy in a primary care setting for major ECG abnormalities, and near-perfect properties for diagnosing AF.

Routine transthoracic echocardiography in ischaemic stroke or transient ischaemic attack of undetermined cause: aprospective multicentre study.

Guidelines recommend routine transthoracic echocardiography (TTE) after ischaemic stroke or transient ischaemic attack of undetermined cause; yet, only limited scientific evidence exists. Therefore, we aimed to determine in these patients the prevalence of TTE-detected major cardiac sources of embolism (CSE), which are abnormalities leading to therapeutic changes. Six Dutch hospitals conducted aprospective observational study that enrolled patients with ischaemic stroke or transient ischaemic attack of undetermined cause. Patients underwent TTE after comprehensive diagnostic evaluation on stroke units, including blood chemistry, 12-lead electrocardiogram (ECG), ≥ 24 h continuous ECG monitoring, brain imaging and cervical artery imaging. Primary outcome measure was the proportion of patients with TTE-detected major CSE. From March 2018 to October 2020, 1084 patients, aged 66.6 ± 12.5 years, were enrolled; 456 (42.1%) patients were female and 869 (80.2%) had ischaemic stroke. TTE detected major CSE in only 11(1.0%) patients. Ten (90.9%) of these patients also had major ECG abnormalities (previous infarction, major repolarisation abnormalities, or previously unknown left bundle branch block) that would have warranted TTE assessment regardless of stroke evaluation. Such ECG abnormalities were present in 11.1% of the total study population. Asingle patient (0.1%) showed amajor CSE despite having no ECG abnormality. This multicentre cross-sectional study in patients who-after workup on contemporary stroke units-were diagnosed with ischaemic stroke or transient ischaemic attack of undetermined cause found TTE-detected major CSE in only 1% of all patients. Most of these patients also had major ECG abnormalities. These findings question the value of routine TTE assessment in this clinical setting.

#4750 PREVALENCE OF ELECTROCARDIOGRAPHIC ABNORMALITIES IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract Background and Aims The presence of electrocardiogram (ECG) abnormalities is high in patients with end-stage kidney disease, but no studies have examined the prevalence of ECG abnormalities according to different strata of estimated glomerular filtration rate (eGFR) in a population-based setting. Method This was a retrospective cross-sectional study including 310,060 individuals from the Copenhagen General Practitioners' Laboratory who had an available digital ECG recorded between 2001 and 2015 and a creatinine measurement within 7 days of the ECG. eGFR was calculated using the The Chronic Kidney Disease Epidemiology Collaboration equation. ECG abnormalities were categorized as no, minor or major, as done previously [1]. Patients with both minor and major ECG abnormalities were assigned as major ECG abnormalities. The prevalence of ECG abnormalities was examined according to different strata of renal function [eGFR (ml/min/1.73 m2) &amp;gt;90, 61–90, 46–60, 31–45, 30-16 and ≤15]. Ordinal logistic regression was used to illustrate the probability of ECG abnormalities as a function of eGFR. Results The median age was 55 [IQR, 41-69] years and 46% were male. A total of 47,249 (17.9%) of the included patients had an eGFR &amp;lt;60. The prevalence of major ECG abnormalities increased with declining eGFR: &amp;gt;90 (16.5%), 61–90 (21.6%), 46–60 (36.5%) 31–45 (52.1%), 30-16 (57.9%) and ≤15 (60.1%). In ordinal logistic regression, the risk of having major ECG abnormalities compared to minor/no abnormalities significantly decreased pr. 5 ml/min increase in eGFR, OR 0.90 (95% CI, 0.85-0.90), Fig. 1. The most common major ECG abnormalities were left ventricular hypertrophy and ST-T deviations. The prevalence of all ECG abnormalities is shown in Table 1. Conclusion ECG abnormalities are common in patients with chronic kidney disease, and the probability of major ECG abnormalities increases with declining eGFR.

Diagnostic accuracy of the PMcardio smartphone application for artificial intelligence–based interpretation of electrocardiograms in primary care (AMSTELHEART-1)

The use of 12-lead electrocardiogram (ECG) is common in routine primary care, however it can be difficult for less experienced ECG readers to adequately interpret the ECG. To validate a smartphone application (PMcardio) as a stand-alone interpretation tool for 12-lead ECG in primary care. We recruited consecutive patients who underwent 12-lead ECG as part of routinely indicated primary care in the Netherlands. All ECGs were assessed by the PMcardio app, which analyzes a photographed image of 12-lead ECG for automated interpretation, installed on an Android platform (Samsung Galaxy M31) and an iOS platform (iPhone SE2020). We validated the PMcardio app for detecting any major ECG abnormality (MEA, primary outcome), defined as atrial fibrillation/flutter (AF), markers of (past) myocardial ischemia, or clinically relevant impulse and/or conduction abnormalities; or AF (key secondary outcome) with a blinded expert panel as reference standard. We included 290 patients from 11 Dutch general practices with median age 67 (interquartile range 55-74) years; 48% were female. On reference ECG, 71 patients (25%) had MEA and 35 (12%) had AF. Sensitivity and specificity of PMcardio for MEA were 86% (95% CI: 76%-93%) and 92% (95% CI: 87%-95%), respectively. For AF, sensitivity and specificity were 97% (95% CI: 85%-100%) and 99% (95% CI: 97%-100%), respectively. Performance was comparable between Android and iOS platform (kappa = 0.95, 95% CI: 0.91-0.99 and kappa = 1.00, 95% CI: 1.00-1.00 for MEA and AF, respectively). A smartphone app developed to interpret 12-lead ECGs was found to have good diagnostic accuracy in a primary care setting for major ECG abnormalities, and near-perfect properties for diagnosing AF.

Electrocardiogram abnormalities and renal impairment in patients with type 2 diabetes mellitus: A healthcare facilities-based cross-sectional study in Dang district of Nepal.

The global burden of diabetes mellitus is rising substantially, with a further increase in cardiovascular and kidney disease burden. These public health problems are highly prevalent in low- and middle-income countries, including Nepal. However, there is limited evidence on cardiac and renal conditions among patients with type 2 diabetes mellitus. We determined the status of electrocardiogram (ECG) abnormalities and renal impairment among patients with type 2 diabetes mellitus in Nepal. We carried out a cross-sectional study in Tulsipur Sub-Metropolitan City of Nepal using a multistage stratified sampling technique to recruit patients with type 2 diabetes mellitus. We used World Health Organization stepwise approach to surveillance (WHO STEPS) questionnaires and carried out resting ECG to collect data of 345 patients with type 2 diabetes mellitus. Logistic regression analysis assessed the factors associated with ECG abnormalities and renal impairment. The study showed that 6.1% of participants had major ECG abnormalities (95% confidence interval [CI] 3.8-8.6%), which were associated with hypertension (P=0.01%) and low socioeconomic status (P=0.01). The proportion of major and/or minor ECG abnormalities was 47.8% (95% CI 40.5-51%), and were significantly associated with age (odds ratio [OR] 1.04, 95% CI 1.01-1.07), higher education (OR 3.50, 95% CI 1.31-9.33), unemployment (OR 3.02, 95% CI 1.08-8.48), body mass index (OR 1.09, 95% CI 1.02-1.17) and duration of type 2 diabetes mellitus >5 years (OR 2.42, 95% CI 1.19-4.93). The proportion of renal impairment was 3.5% (95% CI 1.5-4.5%) which was associated with older age (OR 1.08, 95% CI 1.00-1.17) and hypertension (OR 12.12, 95% CI 1.07-138.22). A significant proportion of patients with type 2 diabetes mellitus had ECG abnormalities and renal impairment, which were significantly associated with hypertension. Therefore, hypertension management and early screening are essential to prevent future cardiorenal complications among patients with type 2 diabetes mellitus.

Electrocardiogram Abnormalities Associated With Metabolic Syndrome: The Hispanic Community Health Study/Study of Latinos.

Metabolic syndrome (MetS) is a prognostic cluster of physiologic risk factors that may develop into cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Electrocardiogram abnormalities (ECGA) can be instrumental in identifying the early stages of disease and may be associated with MetS in Hispanic Americans. To explore the relationships between MetS and major and minor ECGA in the Hispanic population (Hypothesis 1) and determine whether gender-ethnic subgroups moderate these relationships (Hypothesis 2). This secondary data analysis was conducted using large-scale data from the cohort study Hispanic Community Health Study/Study of Latinos (N = 13,628; 59% women and 41% men). Major ECGA encompassed 9 abnormalities including pathologic Q waves and left ventricular hypertrophy. Minor ECGA were tested independently of major ECGA. MetS was classified into 4 categories delineating metabolic abnormalities and related medication use. Multinomial logistic regression and Hayes' PROCESS macro were used for statistical analysis. Major ECGA were significantly associated with the presence of MetS and/or related medication use, whereas minor ECGA abnormalities were associated with MetS for participants who also took MetS-related medications only. Gender moderated the association between MetS and minor ECGA such that women with minor ECGA had a higher likelihood of MetS when compared to men. Findings suggest that early recognition and associated treatment of major and minor ECGA can be important to prevent MetS and further morbidities in the Hispanic population.

Prevalence and clinical significance of isolated low QRS voltages in young athletes.

AimsLow QRS voltages (peak to peak <0.5 mV) in limb leads (LQRSV) on the athlete’s electrocardiogram (ECG) may reflect an underlying cardiomyopathy, mostly arrhythmogenic cardiomyopathy (ACM) or non-ischaemic left ventricular scar (NILVS). We studied the prevalence and clinical meaning of isolated LQRSV in a large cohort of competitive athletes.Methods and resultsThe index group included 2229 Italian competitive athletes [median age 18 years (16–25), 67% males, 97% Caucasian] without major ECG abnormalities at pre-participation screening. Three control groups included Black athletes (N = 1115), general population (N = 1115), and patients with ACM or NILVS (N = 58). Echocardiogram was performed in all athletes with isolated LQRSV and cardiac magnetic resonance (CMR) in those with ventricular arrhythmias or echocardiographic abnormalities. The isolated LQRSV pattern was found in 1.1% index athletes and was associated with increasing age (median age 28 vs. 18 years; P < 0.001), elite status (71% vs. 34%; P < 0.001), body surface area, and body mass index but not with sex, type of sport, and echocardiographic left ventricular mass. The prevalence of isolated LQRSV was 0.2% in Black athletes and 0.3% in young individuals from the general population. Cardiomyopathy patients had a significantly greater prevalence of isolated LQRSV (12%) than index athletes, Black athletes, and general population. Five index athletes with isolated LQSRV and exercise-induced ventricular arrhythmias underwent CMR showing biventricular ACM in 1 and idiopathic NILVS in 1.ConclusionsUnlike cardiomyopathy patients, the ECG pattern of isolated LQRSV was rarely observed in athletes. This ECG sign should prompt clinical work-up for exclusion of an underlying cardiomyopathy.

De novo electrocardiographic abnormalities in persons living with HIV

Persons living with HIV (PLWH) may have increased incidence of cardiovascular events and longer QTc intervals than uninfected persons. We aimed to investigate the incidence and risk factors of de novo major electrocardiogram (ECG) abnormalities and QTc prolongation in well-treated PLWH. We included virologically suppressed PLWH without major ECG abnormalities, who attended the 2-year follow-up in the Copenhagen comorbidity in HIV infection (COCOMO) study. ECGs were categorized according to Minnesota Code Manual. We defined de novo major ECG abnormalities as new major Minnesota Code Manual abnormalities. Prolonged QTc was defined as QTc > 460 ms in females and QTc > 450 ms in males. Of 667 PLWH without major ECG abnormalities at baseline, 34 (5%) developed de novo major ECG abnormalities after a median of 2.3 years. After adjustment, age (RR: 1.57 [1.08–2.28] per decade older), being underweight (RR: 5.79 [1.70–19.71]), current smoking (RR: 2.34 [1.06–5.16]), diabetes (RR: 3.89 [1.72–8.80]) and protease inhibitor use (RR: 2.45 [1.27–4.74) were associated with higher risk of getting de novo major ECG abnormalities. Of PLWH without prolonged QTc at baseline, only 11 (1.6%) participants developed de novo prolonged QTc. Five percent of well-treated PLWH acquired de novo major ECG abnormalities and protease inhibitor use was associated with more than twice the risk of de novo major ECG abnormalities. De novo prolonged QTc was rare and did not seem to constitute a problem in well-treated PLWH.

The prevalence and association of major ECG abnormalities with clinical characteristics and the outcomes of real-life heart failure patients - Heart Failure Registries of the Eu ropean Society of Cardiology.

Electrocardiogram (ECG) abnormalities increase the likelihood of heart failure (HF) but have low specificity and their occurrence is multifactorial. This study aimed to investigate the prevalence and association of major ECG abnormalities with clinical characteristics and outcomes in a large cohort of real-life HF patients enrolled in HF Registries (Pilot and Long-Term) of the European Society of Cardiology. Standard 12-lead ECG containing at least one of the following simple parameters was considered a major abnormality: abnormal rhythm; >100 bpm; QRS ≥120 ms; QTc ≥450 ms; pathological Q-wave; left ventricle hypertrophy; left bundle branch block. A Cox proportional hazards regression model was used to identify predictors of the primary (all-cause death) and secondary (all-cause death or hospitalization for worsening HF) endpoints. Patients with abnormal ECG (1222/1460; 83.7%) were older, more frequently were male and had HF with reduced ejection fraction, valvular heart disease, comorbidities, higher New York Heart Association class, or higher concentrations of natriuretic peptides as compared to those with normal ECG. In a one-year follow-up, the primary and secondary endpoints occurred more frequently in patients with abnormal ECG compared to normal ECG (13.8% vs 8.4%; P = 0.021 and 33.0% vs 24.7%; P = 0.016; respectively). Abnormal rhythm, tachycardia, QRS ≥120 ms, and QTc ≥450 ms were significant in univariable (both endpoints) analyses but only tachycardia remained an independent predictor of the primary endpoint. HF patients with major ECG abnormalities were characterized by worse clinical status and one-year outcomes. Only tachycardia was an independent predictor of all-cause death.

Association between marijuana use and electrocardiographic abnormalities by middle age: the Coronary Artery Risk Development in Young Adults (CARDIA) study.

To evaluate the prevalence of electrocardiogram (ECG) abnormalities in marijuana users as an indirect measure of subclinical cardiovascular disease (CVD). Longitudinal and cross-sectional secondary data analysis from the CARDIA (Coronary Artery Risk Development in Young Adults) study. Four communities in the United States. A total of 2585 participants from the 5115 black and white men and women recruited at age 18-30years in 1985 to 1986 in CARDIA. ECG abnormalities coded as minor and major abnormalities with the Minnesota code of electrocardiographic findings at year20. Self-reported current (past 30days) and computed cumulative life-time marijuana use (one 'marijuana-year' corresponds to 365days of use) through assessments every 2-5years. We fitted logistic regression models adjusting for sex, race, center, education, age, tobacco smoking, physical activity, alcohol use and body mass index. Among the 2585 participants with an ECG at year 20, mean age was 46, 57% were women, 45% were black; 83% had past exposure to marijuana and 11% were using marijuana currently. One hundred and seventy-three participants (7%) had major abnormalities and 944 (37%) had minor abnormalities. Comparing current with never use in multivariable-adjusted models, the odds ratio (OR) for major ECG abnormalities was 0.60 [95% confidence interval (CI)=0.32-1.15] and for minor ECG abnormalities 1.21 (95% CI=0.87-1.68). Results did not change after stratifying by sex and race. Cumulative marijuana use was not associated with ECG abnormalities. In a middle-aged US population, life-time cumulative and occasional current marijuana use were not associated with increases in electrocardiogram abnormalities. This adds to the growing body of evidence that occasional marijuana use and cardiovascular disease events and markers of subclinical atherosclerosis are not associated.

Beneficial effects of benznidazole in Chagas disease: NIH SaMi-Trop cohort study

BackgroundThe effectiveness of anti-parasite treatment with benznidazole in the chronic Chagas disease (ChD) remains uncertain. We evaluated, using data from the NIH-sponsored SaMi-Trop prospective cohort study, if previous treatment with benznidazole is associated with lower mortality, less advanced cardiac disease and lower parasitemia in patients with chronic ChD.MethodsThe study enrolled 1,959 ChD patients and abnormal electrocardiogram (ECG) from in 21 remote towns in Brazil. A total of 1,813 patients were evaluated at baseline and after two years of follow-up. Those who received at least one course of benznidazole were classified as treated group (TrG = 493) and those who were never treated as control group (CG = 1,320). The primary outcome was death after two-year follow-up; the secondary outcomes were presence at the baseline of major ChD-associated ECG abnormalities, NT-ProBNP levels suggestive of heart failure, and PCR positivity.ResultsMortality after two years was 6.3%; it was lower in the TrG (2.8%) than the CG (7.6%); adjusted OR: 0.37 (95%CI: 0.21;0.63). The ECG abnormalities typical for ChD and high age-adjusted NT-ProBNP levels suggestive of heart failure were lower in the TrG than the CG, OR: 0.35 [CI: 0.23;0.53]. The TrG had significantly lower rates of PCR positivity, OR: 0.35 [CI: 0.27;0.45].ConclusionPatients previously treated with benznidazole had significantly reduced parasitemia, a lower prevalence of markers of severe cardiomyopathy, and lower mortality after two years of follow-up. If used in the early phases, benznidazole treatment may improve clinical and parasitological outcomes in patients with chronic ChD.Trial registrationClinicalTrials.gov, Trial registration: NCT02646943.

Predictors of electrocardiographic abnormalities in type 1 Diabetes: the Wisconsin Epidemiologic Study of Diabetic Retinopathy.

To determine the incidence and determinants of developing abnormalities on the 12-lead electrocardiogram (ECG) in persons with type 1 diabetes. We evaluated the distribution of ECG abnormalities and risk factors for developing new abnormalities in 266 (mean age=44years±9.0; 50% female) people with type 1 diabetes from the Wisconsin Epidemiologic Study of Diabetic Retinopathy. This analysis included participants with complete ECG data from study visit 5 (2000-2001) and follow-up ECGs from study visit 7 (2012-2014). ECG abnormalities were classified as major and minor according to Minnesota Code Classification. At baseline, 94 (35%) participants had at least one ECG abnormality, including 13 major ECG abnormalities. At follow-up, 117 (44%) participants developed at least one new ECG abnormality, including 35 new major ECG abnormalities. In a multivariable logistic regression model, older age (per 5-year increase: OR=1.31, 95% CI=1.08, 1.60) was associated with the development of at least one new ECG abnormality, while serum HDL cholesterol (per 10-unit increase: OR=0.98, 95% CI=0.96, 1.00) was protective against developing new ECG abnormalities. The development of new ECG abnormalities is common in type 1 diabetes. Older age and HDL cholesterol are independent risk factors for developing new ECG abnormalities. Further research is needed to determine whether routine ECG screening is indicated in people with type 1 diabetes to identify those with underlying subclinical coronary heart disease.

The ability of an electrocardiogram to predict fatal and non-fatal cardiac events in asymptomatic middle-aged subjects

Introduction: The long-term prognostic value of a standard 12-lead electrocardiogram (ECG) for predicting cardiac events in apparently healthy middle-aged subjects is not well defined.Materials and methods: A total of 9511 middle-aged subjects (mean age 43 ± 8.2 years, 52% males) without a known cardiac disease and with a follow-up 40 years were included in the study. Fatal and non-fatal cardiac events were collected from the national registries. The predictive value of ECG was separately analyzed for 10 and 30 years. Major ECG abnormalities were classified according to the Minnesota code.Results: Subjects with major ECG abnormalities (N = 1131) had an increased risk of cardiac death after 10-years (adjusted hazard ratio [HR] 1.7; 95% confidence interval [95% CI], 1.1–2.5, p = 0.009) and 30-years of follow-up (HR 1.3, 95% CI, 1.1–1.5, p < 0.001). Model discrimination measured with the C-index showed only a minor improvement with the inclusion of ECG abnormalities: 0.851 versus 0.853 and 0.742 versus 0.743 for 10- and 30-year follow-up, respectively. ECG did not predict non-fatal cardiac events after 10-years or 30-years of follow-up.Discussion: Major ECG abnormalities are associated with an increased risk of short and long-term cardiac mortality in middle-aged subjects. However, the improvement in discrimination between subjects with and without fatal cardiac events was marginal with abnormal ECG.KEY MESSAGES:Abnormalities observed on 12-lead electrocardiogram are shown to have prognostic significance for cardiac events in elderly subjects without known cardiac disease.Our results suggest that ECG abnormalities increase the risk of fatal cardiac events also in middle-aged healthy subjects.

Microvasculature and incident atrioventricular conduction abnormalities in the Multi-Ethnic Study of Atherosclerosis (MESA)

Abnormalities of the microvasculature are linked to major cardiac events, but their role in the development of atrioventricular conduction abnormalities (AVCA) is unknown. We examined the association between central retinal arteriolar equivalent (CRAE), a measure of the microvasculature, and incident AVCA. This analysis included 3975 participants free of AVCA at baseline from the Multi-Ethnic Study of Atherosclerosis (MESA). Incident AVCA was defined as a composite of new heart rate-adjusted PR interval ⩾ 200 ms (first-degree AV block) and advanced block (second-degree or complete AV block) detected from the MESA exam 5 electrocardiogram (ECG). CRAE was measured from retinal photographs at exam 2. Both ECGs and retinal photographs were collected using standardized methods and read and graded at central core labs. Incident AVCA were present in 7.4% (n=290) of the participants, of which 94% were first-degree AV block. Incident AVCA were increasingly more common in participants with narrower CRAE (4.6% in Q4, 6.4% in Q3, 7.0% in Q2 and 10.8% in Q1, p-value for trend < 0.0001). The socio-demographic and cardiovascular disease risk-adjusted odds of incident AVCA in the Q1 group (the group with the narrowest retinal arteriolar diameter) was nearly twice the odds in the Q4 group (OR: 1.68, 95% CI: 1.15-2.51). This association remained significant after adjustment for major ECG abnormalities and incident cardiovascular disease (Q1 vs Q4, OR: 1.65, 95% CI: 1.01-2.71). In conclusion, narrower retinal arteriolar caliber is associated with development of new AV conduction abnormalities.

Advanced Electrocardiography Identifies Left Ventricular Systolic Dysfunction in Non-Ischemic Cardiomyopathy and Tracks Serial Change over Time.

Electrocardiogram (ECG)-based detection of left ventricular systolic dysfunction (LVSD) has poor specificity and positive predictive value, even when including major ECG abnormalities, such as left bundle branch block (LBBB) within the criteria for diagnosis. Although machine-read ECG algorithms do not provide information on LVSD, advanced ECG (A-ECG), using multiparameter scores, has superior diagnostic utility to strictly conventional ECG for identifying various cardiac pathologies, including LVSD. Methods: We evaluated the diagnostic utility of A-ECG in a case-control study of 40 patients with LVSD (LV ejection fraction < 50% by echocardiography), due to non-ischemic cardiomyopathy (NICM), and 39 other patients without LVSD. Diagnostic sensitivity and specificity for LVSD were determined after applying a previously validated probabilistic A-ECG score for LVSD to stored standard (10 s) clinical 12L ECGs. In 25 of the NICM patients who had serial ECGs and echocardiograms, changes in the A-ECG score versus in echocardiographic LV ejection fraction were also studied to determine the level of agreement between the two tests. Results: Analyses by A-ECG had a sensitivity of 95% for LVSD (93% if excluding N = 11 patients with LBBB) and specificity of 95%. In the 29 NICM patients without LBBB who had serial ECGs, sensitivity improved to 97% when all ECGs were considered. By comparison, human readers in a busy clinical environment had a sensitivity of 90% and specificity of 63%. A-ECG score trajectories demonstrated improvement, deterioration or no change in LVSD, which agreed with echocardiography, in 76% of cases (n = 25). Conclusion: A-ECG scoring detects LVSD due to NICM with high sensitivity and specificity. Serial A-ECG score trajectories also represent a method for inexpensively demonstrating changes in LVSD. A-ECG scoring may be of particular value in areas where echocardiography is unavailable, or as a gatekeeper for echocardiography.

Electrocardiographic changes in patients of postcerebrovascular accident in rural population of Eastern India

Background: Disorders of the central nervous system cause a wide array of cardiovascular disorders. Aims: The present study was conducted to study the pattern of electrocardiogram (ECG) changes associated with acute stroke in recovery phase among patients without cardiovascular diseases in a rural population of a developing country. Materials and Methods: The present study was conducted in a tertiary care hospital of eastern India in a time span of 1 year. Study group consisted of hundred postcerebrovascular accident (CVA) patients during recovery stage and age and gender matched hundred subjects with no history of CVA or cardiac dysfunction in present or past were chosen as control. Results: Average heart rate of controls was 76.58 ± 6.31 per min and in stroke it was 69.74 ± 12.03 per min. The P value was significant ( P value was significant (0.02* Conclusion: The major ECG abnormalities are S-T segment depression, prolonged corrected Q-T interval and abnormalities in heart rate and rhythm following CVA and are nearly identical in ischemic and haemorrhagic CVA. The patients of acute CVA in developing countries need to be treated with proper follow-up considering the neurological as well as cardiological complications.