Minor ECG Abnormalities Research Articles

Association Between ECG Abnormalities and Mortality in a Low-Risk Population.

The ECG is a simple, noninvasive screening method for cardiovascular disease and arrhythmia. The impact of ECG abnormality on mortality is not certain in low-risk populations. To address this, we evaluated the association between ECG abnormality and mortality. We retrospectively assessed baseline ECG and all-cause mortality and cardiovascular mortality in 660 383 patients presenting for medical check-ups. Baseline ECG abnormalities were classified according to the Minnesota Code. Among the total 660 383 participants, 23 609 (3.6%) had major and 110 038 (16.7%) had minor ECG abnormalities. All-cause mortality occurred in 7751 patients (1.1%) and cardiovascular mortality in 1180 (0.18%) over a median follow-up period of 8.8 years. Major ECG abnormalities were associated with all-cause mortality (hazard ratio [HR], 1.11 [95%, 1.03-1.2]) and cardiovascular mortality (HR, 1.92 [95% CI, 1.63-2.27]) compared with no ECG abnormalities. All-cause mortality was associated with right atrial enlargement (HR, 2.11 [95% CI, 1.1-4.07]), left atrial enlargement (HR, 1.76 [95% CI, 1.1-2.84]), sinus tachycardia (HR, 1.52 [95% CI, 1.15-2.01]), complete atrioventricular block (HR, 2.1 [95% CI, 1.05-4.2]), atrial fibrillation (HR, 1.52 [95% CI, 1.26-1.84]), and left ventricular hypertrophy (HR, 1.15 [95% CI, 1.02-1.3]). Cardiovascular mortality was associated with left atrial enlargement (HR, 4.52 [95% CI, 2.15-9.5]), atrial fibrillation (HR, 3.22 [95% CI, 2.33-4.46]), left ventricular hypertrophy (HR, 1.72 [95% CI, 1.35-2.19]), major Q-wave abnormality (HR, 1.6 [95% CI, 1.08-2.39]), and major ST-T abnormality (HR, 1.76 [95% CI, 1.01-3.04]). ECG abnormalities, including left atrial enlargement, left ventricular hypertrophy, atrial fibrillation, and major Q-wave and ST-T abnormalities, were associated with cardiovascular mortality in a low-risk population.

#4771 PROGNOSTIC RELEVANCE OF ELECTROCARDIOGRAPHIC ABNORMALITIES ACCORDING TO EGFR CATEGORIES

Abstract Background and Aims Electrocardiogram (ECG) abnormalities are associated with adverse cardiovascular outcomes in patients with chronic kidney disease (CKD), but their prognostic relevance according to estimated glomerular filtration rate (eGFR) categories remains unexplored. This study investigated the associations between no, minor, and major ECG abnormalities and fatal cardiovascular disease (CVD) according to different strata of renal function. Method This was a retrospective cohort study including 310.060 individuals aged ≥16 years from the Copenhagen General Practitioners' Laboratory that had an available digital ECG and creatinine measurement within 7 days from 2001–2015. eGFR was calculated using The Chronic Kidney Disease Epidemiology Collaboration equation, and data were cross-linked with Danish nation-wide healthcare registries to gain information on medication, comorbidity, and fatal CVD. ECG abnormalities were categorized as either no abnormalities, minor (first-degree atrioventricular block, incomplete bundle branch block or corrected QT prolongation) or major (left ventricular hypertrophy, atrial fibrillation/flutter, bundle branch block, Q waves, or ST-T deviations), as done previously [1]. Patients with both minor and major ECG abnormalities were assigned as major ECG abnormalities. ECG abnormalities and their association with fatal CVD were compared across strata of renal function [eGFR (ml/min/1.73m2) >90, 61–90, 46–60, 31–45, 16–30 and ≤15] based on multivariable Cox-regression analysis adjusted for age, sex, and comorbidities. Counterfactual G-estimation of Hazard Ratios (HRs) standardized to age and sex was performed to estimate 5-year absolute risk of fatal CVD. Results The median age was 55 [IQR, 41-69] years and 46% were male. Median study follow-up time was 10.3 [IQR, 6.7-14.4] years. A total of 47,249 (17.9%) of the included patients had an eGFR <60. The rate of fatal CVD according to ECG abnormalities and their adjusted HRs is shown in Fig. 1, while 5-year standardized risk of fatal CVD is depicted in Fig. 2. Generally, having minor or major ECG abnormalities, conferred a worse prognosis across all eGFR strata, with the highest 5-year absolute risk of fatal CVD being observed among patients with major ECG abnormalities and an eGFR between 31–45 [19% (95% CI, 18–20%)], eGFR 16–30 [25% (95% CI, 24–26%)] or an eGFR ≤15 [27.5% (95% CI, 24–31%)], Fig. 1–2. Conclusion In a population-based setting, having minor or major ECG abnormalities were associated with an increased risk of fatal CVD across all strata of renal function. Patients with an eGFR ≤45 and major ECG abnormalities represent a high-risk population, that might benefit from careful monitoring and cardiovascular risk management.

Major and minor ECG abnormalities depending on regional living conditions in Russia

The goal of our study was to explore the effect of living conditions on the odd of major and minor ECG abnormalities on a large region scale in Russia. For the analysis, cross-sectional data of the Russian study, ESSE-RF 2013–2014, were used. They were collected on a sample of 16,400 subjects from 10 regions of the Russia. ECG abnormalities were grouped into two categories: Major and Minor (sensu the 2009 version of the Minnesota Code Classification System). Regional living conditions were considered comprehensively via five indices combining 33 characteristics of the regions. The estimates were presented as odds ratios and their 95% confidence intervals. The prevalence values of major abnormalities in the sample were 8.4% among women and 9.4% among men (p = 0.021). The prevalence of minor abnormalities constituted 34.1% and 45.9%, respectively (p < 0.001). In men, the odd of major ECG abnormalities increased with the demographic depression growth (1.08: 1.04–1.12) and with industrial development growth in the region (1.12: 1.07–1.17). In women, an increase in the odd of major ECG abnormalities was directly associated with industrial development (1.12: 1.07–1.16) and inversely related to the economic development in the region (0.94: 0.89–0.99). The odd of minor ECG abnormalities in men and women declined with the growth of the regional economic development: OR of 0.95: 0.93–0.98, and OR of 0.92: 0.87–0.99, respectively. The study demonstrated an effect of regional living conditions of the Russian population on the odd of major and minor ECG abnormalities. The most stable and logically explainable relationships were obtained for industrial and economic characteristics of living conditions.

Acute pericarditis in patients receiving coronavirus disease 2019 vaccines: a case series from the community.

International agencies reported that cases of pericarditis occur very rarely following the administration of coronavirus disease 2019 (COVID-19) vaccines. Herewith, we described a series of patients from the community diagnosed with acute pericarditis after vaccination. We retrospectively included 28 patients (median age 51 years, 79% female) with or without a positive history of acute respiratory syndrome coronavirus 2 recovered infection who were diagnosed with acute pericarditis following the administration of COVID-19 vaccine. We excluded specific identifiable causes of pericarditis, including infectious, autoimmune, neoplastic and metabolic disease. Patients were referred for a complete cardiovascular evaluation. Transthoracic echocardiography (TTE) was performed and diagnosis of acute pericarditis was achieved according to current guidelines. There were 16 patients administered with Pfizer-BioNTech/Comirnaty vaccine, 8 with Moderna/Spikevax vaccine and 4 with Astra Zeneca/Vaxzevria vaccine. Nine patients had been previously diagnosed with COVID-19, while the others had no prior history of COVID-19. Eleven patients had no comorbidity while the others had between one and four comorbidities. Ten patients had a history of rheumatic or autoimmune diseases. Chest pain was present in 24 patients. Minor ECG abnormalities were detected in 10 patients, T-wave inversion in 6, and 7 patients had concave ST elevation. The majority of patients showed mild pericardial effusions at TTE. Only two patients exhibited large pericardial effusions. This case series shows a higher incidence of acute pericarditis in patients administered with COVID-19 vaccines than previously estimated, probably because of a more comprehensive assessment of clinical as well as echocardiographic parameters.

Prevalence of major and minor electrocardiographic abnormalities and their relationship with cardiovascular risk factors in Angolans.

AimsTo identify the prevalence of major and minor electrocardiographic abnormalities and their association with the main risk factors for cardiovascular disease in a population in the province of Bengo, northern Angola.MethodsA cross-sectional community-based study was conducted and a representative random sample stratified by sex and age was selected. In total, 2379 black individuals were included in the final analysis. A standard 12-lead ECG were recorded from all participants, analyzed and processed by the University of Glasgow software and coding by the Minnesota code.Results22.3% of participants had minor electrocardiographic abnormalities and 4.58% major ECG abnormalities. The most common minor ECG abnormalities were abnormal T wave inversion, minor isolated ST abnormalities and premature beats. The most common major ECG abnormalities were Left ventricular hypertrophy with major ST-T abnormalities, Ventricular conduction defects and major Q-wave abnormalities. Hypertension, diabetes mellitus, hypercholesterolemia, alcohol consumption and smoking, were significantly associated with major and minor electrocardiographic abnormalities.ConclusionsIn this study several participants had minor and major electrocardiographic abnormalities. Minor electrocardiographic abnormalities were more prevalent in men and major abnormalities in women. The electrocardiographic abnormalities had significant associations with the main cardiovascular risk factors.

Clinical values of resting electrocardiography in patients with known or suspected chronic coronary artery disease: a stress perfusion cardiac MRI study

BackgroundElectrocardiography (ECG) is an essential investigation in patients with chronic coronary artery disease (CAD). However, evidence regarding the diagnostic and prognostic value of ECG in this population is limited. Therefore, we sought to determine whether baseline ECG abnormalities were associated with myocardial ischemia and cardiac events in patients with known or suspected chronic CAD.MethodsConsecutive patients with known (n = 146) or suspected chronic CAD (n = 349) referred for adenosine stress cardiac magnetic resonance (CMR) between 2011 and 2014 were enrolled. Resting ECGs were classified as major, minor, and no abnormalities. Predictors of myocardial ischemia on CMR and major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, hospitalization for heart failure and late revascularization (> 180 days after CMR) were evaluated.ResultsAverage age was 69 ± 11 years (51% men). One hundred and eighty-five patients (37.4%) had major and 154 (31.1%) had minor ECG abnormalities. In patients with suspected CAD, myocardial ischemia was presented in 83 patients (23.8%). Multivariable analysis demonstrated major ECG abnormality as the strongest predictor of myocardial ischemia (HR 2.51; 95% CI 1.44–4.36; p = 0.001). Adding ECG to clinical pretest probability models improved the prediction of myocardial ischemia in ROC analyses (p = 0.04). In the whole cohort (n = 495), 91 MACE occurred during the median follow-up period of 4.8 years. Multivariable analysis showed that diabetes mellites, history of heart failure, prior revascularization, left ventricular ejection fraction, ischemia, and major ECG abnormality were independent predictors of MACE.ConclusionAbnormal resting ECG is common in patients with known or suspected chronic CAD. ECG had important diagnostic and prognostic values in this population.

Prevalence of ECG abnormalities in people with type 2 diabetes: The Hoorn Diabetes Care System cohort.

The American Diabetes Association, and the joint European Society of Cardiology and European Association for the Study of Diabetes guidelines recommend a resting ECG in people with type 2 diabetes with hypertension or suspected cardiovascular disease (CVD). However, knowledge on the prevalence of ECG abnormalities is incomplete. We aimed to analyse the prevalence of ECG abnormalities and their cross-sectional associations with cardiovascular risk factors in people with type 2 diabetes. We used data of the Diabetes Care System cohort obtained in 2018. ECG abnormalities were defined using the Minnesota Classification and categorised into types of abnormalities. The prevalence was calculated for the total population (n = 8068) and the subgroup of people without a history of CVD (n = 6494). Logistic regression models were used to asses cross-sectional associations. Approximately one-third of the total population had minor (16.0%) or major (13.1%) ECG abnormalities. Of the participants without a CVD history, approximately one-quarter had minor (14.9%) or major (9.1%) ECG abnormalities, and for those with hypertension or very high CVD risk, the prevalence was 27.5% and 39.6%, respectively. ECG abnormalities were significantly and consistently associated with established CVD risk factors. Resting ECG abnormalities are common in all people with type 2 diabetes (29.1%), including those without a history of CVD (24.0%), and their prevalence is related to traditional cardiovascular risk factors such as older age, male sex, hypertension, lower HDL cholesterol, higher BMI, and smoking behaviour.

Do sex differences in the prevalence of ECG abnormalities vary across ethnic groups living in the Netherlands? A cross-sectional analysis of the population-based HELIUS study

ObjectivesMajor ECG abnormalities have been associated with increased risk of cardiovascular disease (CVD) burden in asymptomatic populations. However, sex differences in occurrence of major ECG abnormalities have been poorly studied,...

Electrocardiographic ST-T Abnormities Are Associated With Stroke Risk in the REGARDS Study.

Background and Purpose- In previous studies, isolated nonspecific ST-segment and T-wave abnormalities (NSSTTAs), a common finding on ECGs, were associated with greater risk for incident coronary artery disease. Their association with incident stroke remains unclear. Methods- The REGARDS (Reasons for Geographic and Racial Differences in Stroke) study is a population-based, longitudinal study of 30 239 white and black adults enrolled from 2003 to 2007 in the United States. NSSTTAs were defined from baseline ECG using the standards of Minnesota ECG Classification (Minnesota codes 4-3, 4-4, 5-3, or 5-4). Participants with prior stroke, coronary heart disease, and major and minor ECG abnormalities other than NSSTTAs were excluded from analysis. Multivariable Cox proportional hazards regression was used to examine calculate hazard ratios of incident ischemic stroke by presence of baseline NSSTTAs. Results- Among 14 077 participants, 3111 (22.1%) had NSSTTAs at baseline. With a median of 9.6 years follow-up, 106 (3.4%) with NSSTTAs had ischemic stroke compared with 258 (2.4%) without NSSTTAs. The age-adjusted incidence rates (per 1000 person-years) of stroke were 2.93 in those with NSSTTAs and 2.19 in those without them. Adjusting for baseline age, sex, race, geographic location, and education level, isolated NSSTTAs were associated with a 32% higher risk of ischemic stroke (hazard ratio, 1.32 [95% CI, 1.05-1.67]). With additional adjustment for stroke risk factors, the risk of stroke was increased 27% (hazard ratio, 1.27 [95% CI, 1.00-1.62]) and did not differ by age, race, or sex. Conclusions- Presence of NSSTTAs in persons with an otherwise normal ECG was associated with a 27% increased risk of future ischemic stroke.

Chest Pain in Pediatrics, Local Center Experience

Background: Chest pain in children might cause anxiety for the patient and his/her family. It was reported that a follow up of chest pain in pediatrics doesn't increase the risk of sudden cardiac death. Materials and methods: A retrospective review of all pediatric cases referred with a complaint of chest pain to pediatric cardiology-PSCC-Qassim since 2006. Families were contacted to review the child condition and the status of the chest pain complaint and any medical problems the child might have. Results: A total of 242 pediatric cases were referred with a complaint of chest pain since 2006. 135 (56%) were females. The age & weight at referral was 2 to 14 years and 5 to 71 kg. 16 (6.7%) patients reported that there is a relation between chest pain and exercise. The most frequent associated symptom was palpitations. Clinically 50 cases (20.6%) had cardiac murmurs with normal general, cardiac and other organ systems exam. 12 patients had minor ECG abnormalities (PACs, PVCs, borderline long QT). 23 patients (9.5%) had abnormal echo findings in the form of BAV, ASD, PFO, MVP, and PAPVD. By Telephone contact of the families, the current age of those referred is 4 to 22 years (average 12.8 +/- 3.3 years). 195 families (80.6%) reported that their children have no more chest pain. 48 children (19.8%) reported that they are still having nonspecific chest pain which didn't interfere with the child living conditions. 13 children (5.4%) have medical problems (e.g. bronchial asthma, anemia, hyperthyroidism, etc. ). All are alive with no reported cardiac events. Conclusion: Chest pain in pediatrics is a benign condition. A proper assessment will decrease referrals and the use of extensive investigations. It is less likely to affect the child daily activities and doesn’t increase the risk of sudden cardiac death.

Long-term favorable cardiovascular risk profile and 39-year development of major and minor electrocardiographic abnormalities – The Chicago Healthy Aging Study (CHAS)

BackgroundData are limited on long-term associations of favorable cardiovascular risk profile (i.e., low-risk) and changes in risk profile with ECG abnormality development. MethodsThe Chicago Healthy Aging Study (CHAS) involved re-examination of 1395 participants, ages 65–84 years in 2007–10, free of baseline major ECG abnormalities or MI in 1967–1973. Stratified sampling method was used to recruit participants based on their baseline risk profile (low-risk and not low-risk). Low-risk status was defined as untreated SBP/DBP ≤ 120/≤80 mm Hg, untreated total cholesterol <200 mg/dl, not smoking, BMI <25 kg/m2, and no diabetes. ECG abnormalities were defined by Minnesota code criteria. Multinomial logistic regression was used. ResultsThere were 28% women, 9% blacks, and 20% with baseline low-risk status. At follow-up, 21% developed ≥1 major ECG abnormalities, and 58% developed ≥1 minor ECG abnormalities. With multivariable adjustment, compared to those with 2 + high-risk factors, odds for developing from normal to any major ECG abnormalities were lower by 57%, 49%, and 35%, respectively, in persons with low-risk, any moderate-risk, and 1 high-risk factor (P-trend = 0.002). Findings were similar for some common specific subtypes of major and minor abnormalities. Associations were mainly due to baseline smoking and BMI. Remaining free of high-risk factors, or improving risk profile over time was also associated with lower major ECG abnormality development by 70% vs. always having any high-risk factor. ConclusionsFavorable CVD risk profile earlier in life and maintenance or improvement in risk profile over time are associated with lower risk of ECG abnormality development at older age.

Amiodarone and Trypanosoma cruzi parasitemia in patients with Chagas disease

Amiodarone and Trypanosoma cruzi parasitemia in patients with Chagas disease

Electrocardiographic deep terminal negativity of the P wave in V1 and risk of mortality: the National Health and Nutrition Examination Survey III.

Deep terminal negativity of P wave in V1 (DTNPV1), defined as negative P prime larger than one small box (1 mm, or 0.1 mV), could be easily detected by simple visual inspection of the resting 12-lead ECG. The objective of this study was to determine the relationship between DTNPV1 and all-cause-, cardiovascular disease (CVD), and ischemic heart disease (IHD) mortality in the National Health and Nutrition Examination Survey III (NHANES III). After exclusion of participants with atrial fibrillation and missing data, DTNPV1 was automatically measured from standard 12-lead ECG in 8,146 participants. Minnesota and Novacode algorithms were used for the determination of major and minor ECG abnormalities. National Death Index was used to identify the date and cause of death. During a median follow-up of 13.8 years, a total of 2,975 deaths (1,303 CVD and 742 IHD deaths) occurred. After adjustment for age, gender, race/ethnicity, IHD, heart failure, chronic obstructive pulmonary disease, cancer, diabetes, body mass index, smoking, dyslipidemia, hypertension, use of antihypertensive and lipid-lowering medications, and ECG abnormalities, DTNPV1 was associated with significantly increased risk of all-cause death (HR [95% CI]: 1.30 [1.10, 1.53]; P = 0.002), CVD death (HR [95% CI]: 1.36 [1.08, 1.72]; P = 0.010), and IHD death (HR [95% CI]: 1.36 [1.00, 1.85]; P = 0.047). In a large sample of the adult United States population, DTNPV1 is independently associated with increased risk of death due to all-cause, CVD, and IHD, findings suggesting its potential usefulness as a simple marker to identify individuals at risk of poor outcomes.

Prevalence and determinants of electrocardiographic abnormalities in African Americans with type 2 diabetes

BackgroundElectrocardiographic (ECG) abnormalities are independently associated with poor outcomes in the general population. Their prevalence and determinants were assessed in the understudied African American population with type 2 diabetes. MethodsStandard 12-lead ECGs were digitally recorded in 635 unrelated African American-Diabetes Heart Study (AA-DHS) participants, automatically processed at a central lab, read, and coded using standard Minnesota ECG Classification. Age- and sex-specific prevalence rates of ECG abnormalities were calculated and logistic regression models were fitted to examine cross-sectional associations between participant characteristics and ECG abnormalities. ResultsParticipants were 56% women with a mean age of 56years; 60% had at least one minor or major ECG abnormality [23% ⩾1 major (or major plus minor), and 37% ⩾1 minor (with no major)]. Men had a higher prevalence of ⩾1 minor or major ECG abnormality (66.1% men vs. 55.6% women, p=0.0089). In univariate analysis, age, past history of cardiovascular disease, diabetes duration, systolic blood pressure, sex and statin use were associated with the presence of any (major or minor) ECG abnormalities. In a multivariate model including variables, female sex (OR [95% CI] 0.79 [0.67, 0.93]), statin use (0.79 [0.67, 0.93]) and diabetes duration (1.03 [1.0, 1.05]) remained statistically significant. ConclusionsNearly three out of five African Americans with diabetes had at least one ECG abnormality. Female sex and statin use were significantly associated with lower odds of any ECG abnormality and diabetes duration was significantly associated with higher odds of any ECG abnormality in the multivariable model.

Early ECG Abnormalities in Elderly Linked to Increased CHD

Both major and minor abnormalities on electrocardiograms signaled an increased risk of coronary heart disease within 8 years among elderly people in the general population, according to a report in JAMA. Adding ECG abnormalities to traditional cardiovascular risk factors in a risk prediction model modestly but significantly improved the prediction of coronary heart disease events, said Dr. Reto Auer of the department of epidemiology and biostatistics, University of California, San Francisco, and associates. To date, few studies have examined whether ECG abnormalities could improve risk prediction in older adults, and none has adequately adjusted for the presence of traditional cardiovascular risk factors. Predicting CHD with traditional risk factors is less accurate in the elderly than in other patient populations, the investigators noted. Dr. Auer and colleagues examined the issue using data from the Health, Aging, and Body Composition (Health ABC) Study, a population-based cohort study of community-dwelling men and women who were aged 70–79 years at baseline in 1997–1998. For their secondary analysis of data, the investigators assessed a random sample of 2,192 subjects living near Pittsburgh or Memphis, Tenn., who had no evidence of cardiovascular disease and who underwent standard ECG at baseline and again 4 years later. The mean age of the study subjects was 73.5 years. Just over half were women, and 41% were black. Major ECG abnormalities were defined as Q–QS wave abnormalities, left ventricular hypertrophy, Wolff-Parkinson-White syndrome, complete bundle branch block or intraventricular block, atrial fibrillation, atrial flutter, or major ST–T changes. Minor ECG abnormalities were defined as minor ST–T changes. A total of 506 subjects (23%) showed major and 276 (13%) showed minor ECG abnormalities at baseline. During a median follow-up of 8 years, 351 study subjects had CHD events, including 96 CHD deaths, 101 acute myocardial infarctions, and 154 hospitalizations for angina or coronary revascularization. There also were 506 deaths from non-CHD causes. The rate of CHD events was 17.2 per 1,000 person-years among subjects with no ECG abnormalities. This was significantly lower than the rate among subjects with minor ECG abnormalities (29.3 per 1,000 person-years) and the rate among those with major ECG abnormalities (31.6 per 1,000 person-years), said Dr. Auer, who is also of the University of Lausanne (Switzerland), and associates. After the data were adjusted to account for risk factors such as subject age, sex, total and HDL cholesterol levels, blood pressure, smoking status, and diabetes status, the hazard ratio for CHD events for subjects with minor ECG abnormalities was 1.35 and the hazard ratio for CHD events for subjects with major ECG abnormalities was 1.51, compared with subjects who had no ECG abnormalities at baseline, the researchers said in the JAMA report (JAMA 2012;307:1497–1505). The findings were similar when the data were analyzed by race. Adding ECG data to a prediction model for the subgroup of subjects at intermediate cardiovascular risk resulted in reclassifying 8% of them as high-risk and 6% of them as low-risk. A total of 1,670 study participants underwent a second ECG at 4 years; 416 of them had a persistent ECG abnormality and 208 had a new ECG abnormality During a median follow-up of 6.4 years, 185 of these subjects had CHD events, including 57 who died from CHD. The analysis found that both new and persistent ECG abnormalities at 4 years were associated with an increased risk of CHD events. The absolute risk was 33.2 per 1,000 person-years in those with new abnormalities and 27.8 per 1,000 person-years in those with persistent ECG abnormalities. The findings indicate that ECG screening may be useful in the elderly population – especially in view of the fact that 36% of the study population was found to have ECG abnormalities at baseline, a rate much higher than that in younger adults. ECG screening is already known to be safe, low cost, and widely available, the researchers said. However, in their conclusion they conceded that the benefit of such screening was small in this study and that even these results must be validated in other cohorts as well as in prospective clinical trials. Dr. Auer's associates reported ties to Amgen, Bayer, Boston Scientific, Cardiomems, Corthera, GE Healthcare, Medtronic, Novartis, Ono Pharmaceutical, Takeda, Trevena, and World Heart.

N-terminal pro-B-type natriuretic peptide and the prediction of primary cardiovascular events: results from 15-year follow-up of WOSCOPS

AimsTo test whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) was independently associated with, and improved the prediction of, cardiovascular disease (CVD) in a primary prevention cohort.Methods and resultsIn the West of Scotland Coronary Prevention Study (WOSCOPS), a cohort of middle-aged men with hypercholesterolaemia at a moderate risk of CVD, we related the baseline NT-proBNP (geometric mean 28 pg/mL) in 4801 men to the risk of CVD over 15 years during which 1690 experienced CVD events. Taking into account the competing risk of non-CVD death, NT-proBNP was associated with an increased risk of all CVD [HR: 1.17 (95% CI: 1.11–1.23) per standard deviation increase in log NT-proBNP] after adjustment for classical and clinical cardiovascular risk factors plus C-reactive protein. N-terminal pro-B-type natriuretic peptide was more strongly related to the risk of fatal [HR: 1.34 (95% CI: 1.19–1.52)] than non-fatal CVD [HR: 1.17 (95% CI: 1.10–1.24)] (P= 0.022). The addition of NT-proBNP to traditional risk factors improved the C-index (+0.013; P < 0.001). The continuous net reclassification index improved with the addition of NT-proBNP by 19.8% (95% CI: 13.6–25.9%) compared with 9.8% (95% CI: 4.2–15.6%) with the addition of C-reactive protein. N-terminal pro-B-type natriuretic peptide correctly reclassified 14.7% of events, whereas C-reactive protein correctly reclassified 3.4% of events. Results were similar in the 4128 men without evidence of angina, nitrate prescription, minor ECG abnormalities, or prior cerebrovascular disease.ConclusionN-terminal pro-B-type natriuretic peptide predicts CVD events in men without clinical evidence of CHD, angina, or history of stroke, and appears related more strongly to the risk for fatal events. N-terminal pro-B-type natriuretic peptide also provides moderate risk discrimination, in excess of that provided by the measurement of C-reactive protein.Clinical trial registrationWOSCOPS was carried out and completed prior to the requirement for clinical trial registration.

Artificial neural networks versus proportional hazards Cox models to predict 45-year all-cause mortality in the Italian Rural Areas of the Seven Countries Study.

BackgroundProjection pursuit regression, multilayer feed-forward networks, multivariate adaptive regression splines and trees (including survival trees) have challenged classic multivariable models such as the multiple logistic function, the proportional hazards life table Cox model (Cox), the Poisson’s model, and the Weibull’s life table model to perform multivariable predictions. However, only artificial neural networks (NN) have become popular in medical applications.ResultsWe compared several Cox versus NN models in predicting 45-year all-cause mortality (45-ACM) by 18 risk factors selected a priori: age; father life status; mother life status; family history of cardiovascular diseases; job-related physical activity; cigarette smoking; body mass index (linear and quadratic terms); arm circumference; mean blood pressure; heart rate; forced expiratory volume; serum cholesterol; corneal arcus; diagnoses of cardiovascular diseases, cancer and diabetes; minor ECG abnormalities at rest. Two Italian rural cohorts of the Seven Countries Study, made up of men aged 40 to 59 years, enrolled and first examined in 1960 in Italy. Cox models were estimated by: a) forcing all factors; b) a forward-; and c) a backward-stepwise procedure. Observed cases of deaths and of survivors were computed in decile classes of estimated risk. Forced and stepwise NN were run and compared by C-statistics (ROC analysis) with the Cox models. Out of 1591 men, 1447 died. Model global accuracies were extremely high by all methods (ROCs > 0.810) but there was no clear-cut superiority of any model to predict 45-ACM. The highest ROCs (> 0.838) were observed by NN. There were inter-model variations to select predictive covariates: whereas all models concurred to define the role of 10 covariates (mainly cardiovascular risk factors), family history, heart rate and minor ECG abnormalities were not contributors by Cox models but were so by forced NN. Forced expiratory volume and arm circumference (two protectors), were not selected by stepwise NN but were so by the Cox models.ConclusionsThere were similar global accuracies of NN versus Cox models to predict 45-ACM. NN detected specific predictive covariates having a common thread with physical fitness as related to job physical activity such as arm circumference and forced expiratory volume. Future attention should be concentrated on why NN versus Cox models detect different predictors.

016 Young patients with heart failure often do not have major ECG abnormalities

BackgroundIt is commonly held that a normal ECG rules out the diagnosis of heart failure1; however this has only been demonstrated in the elderly.2 Do young people with heart failure...

Abstract MP087: Relation of Risk Factor Profile at Baseline and 39-Year Follow-up to Peripheral Arterial Disease - - The Chicago Healthy Aging Study (CHAS)

Background: Low burden of CVD risk factors (RF) at younger ages is associated with substantially reduced risk for future clinical CVD events. There is no information available regarding associations of long-term patterns in RF profile, from young adulthood to older age, with prevalence at older age of low ankle brachial index (ABI), a marker for peripheral arterial disease (PAD). Methods: Using data from the Chicago Healthy Aging Study (CHAS), we assessed associations of patterns in RF profile -- from baseline (1967-73) to follow-up (2007-10) -- with prevalence of PAD at follow-up (see Table for definitions of RFs and RF groups). ABI was calculated as the ratio of Doppler recorded systolic pressures in the lower and upper extremities, and categorized as follows: low ABI/PAD (ABI&lt;1.00) vs. normal (1.00 ≤ABI ≤1.40). Participants with an ABI &gt;1.40 (n=24) were excluded from the analysis. Results: The study sample consisted of 1,340 participants (27.8% women, 9.2% African Americans) ages 24-45 years, free of major ECG abnormalities and MI at baseline. After 39 years of follow-up, 15.5 percent of persons with no adverse baseline RF levels remained RF-free at follow-up (Group A). The prevalence of PAD was lowest in this Group A (3.7%) and highest (19.9% -- 5 times higher) in Group E, with ≥2 RFs at both baseline and follow-up (p-value &lt; .001). Likewise, with adjustment for baseline age, sex, ethnicity, education, and minor ECG abnormalities, the odds for PAD in Group A was lowest compared with other groups. Further, decrease in number of RFs from baseline to follow-up (Group C) was associated with lower likelihood for PAD compared to increase in number of RFs over time (Groups B and D) and to presence of ≥2 RFs at both baseline and follow-up (Group E). Conclusion: Long-term absence of risk factors is associated with lowest prevalence of PAD at 39 year follow-up. Greater risk factor burden in young adulthood and development of risk factors over decades were both associated with greater likelihood of PAD later in life.

Dilated Cardiomyopathy With Conduction Disease and Arrhythmia

case presentation: A 48-year-old woman presents with exertional dyspnea and recurrent syncope. One year earlier, a permanent pacemaker was placed after she complained of fatigue and was found to have high-grade atrioventricular block. Now, she has echocardiographic evidence of moderate to severe left ventricular (LV) systolic dysfunction with regional wall-motion abnormalities. Nuclear imaging is notable for heterogeneous myocardial uptake of technetium Tc99m sestamibi, and coronary angiography reveals widely patent epicardial vessels. Multiple episodes of nonsustained ventricular tachycardia (VT) are documented on continuous ECG monitoring. What are the diagnostic considerations for this patient, and what further evaluations are indicated? This patient presents with dilated cardiomyopathy (DCM) with electric instability (DCM+E), which we define as conduction disease and arrhythmia out of proportion to the severity of LV systolic dysfunction. Diverse causes can result in DCM+E and fall into general categories of inflammatory, infectious, hereditary, and infiltrative processes. Cardiac presentation associated with these conditions is distinct from more common causes of DCM such as ischemic heart disease, viral myocarditis, valvular dysfunction, pregnancy, or substance abuse. Clinical features that are suggestive of DCM+E include supraventricular arrhythmias or conduction disease that precedes cardiomyopathy, multiple VT morphologies, and features suggestive of ischemic heart disease (Q waves, regional wall-motion abnormalities, perfusion defects, ventricular aneurysm) in the absence of epicardial stenoses. In this Clinician Update, we focus on the diagnostic approach to patients with DCM+E. Emphasis is placed on diagnoses that are relatively common or for which the clinical management would be impacted significantly by recognition of the underlying cause. Ischemic heart disease may present with conduction disease and a high burden of arrhythmia, especially in the setting of acute myocardial ischemia/infarction. The exclusion of obstructive coronary artery disease is strongly recommended in patients with DCM+E because atherosclerosis is so prevalent, evidence-based treatment is readily available, and the …