Minor Electrocardiographic Abnormalities Research Articles

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.

Association of minor electrocardiographic (ECG) abnormalities with epilepsy duration in children: A manifestation of the epileptic heart?

PurposeCardiac abnormalities resulting from chronic epilepsy (“the epileptic heart”) constitute a well-recognized comorbidity. However, the association of cardiac alterations with epilepsy duration remains understudied. We sought to evaluate this association using electrocardiogram (ECG). MethodsWe prospectively enrolled children between 1 months and 18 years of age without known cardiac conditions or ion channelopathies during routine clinic visits. ECGs were categorized as abnormal if there were alterations in rhythm; PR, QRS, or corrected QT interval; QRS axis or morphology; ST segment or T wave. An independent association between ECG abnormalities and epilepsy duration was evaluated using multivariable logistic regression modeling. Results213 children were enrolled. 100 ECGs (47%) exhibited at least one alteration; most commonly in the ST segment (37, 17%) and T wave (29, 11%). Children with normal ECGs had shorter epilepsy duration as compared to those with ECG abnormalities (46 [18–91] months vs. 73 [32–128 months], p = 0.004). A multivariable logistic regression model demonstrated that increasing epilepsy duration was independently associated with the presence of ECG abnormalities (OR=1.09, 95% CI=1.02–1.16, p = 0.008), adjusted for seizure frequency, generalized tonic-clonic/focal to bilateral tonic-clonic seizures as the predominant seizure type, and number of channel-modifying anti-seizure medications. Increasing epilepsy duration was also independently associated with the presence of ST/T wave abnormalities (OR=1.09, 95% CI=1.01–1.16, p = 0.017), adjusted for the same covariates. SignificanceIncreasing epilepsy duration is independently associated with the presence of minor ECG abnormalities. Additional studies are needed to evaluate whether this finding may represent a manifestation of the “epileptic heart”.

Age and gender differences of basic electrocardiographic values and abnormalities in the general adult population; Tehran Cohort Study

BackgroundAlthough several studies are available regarding baseline Electrocardiographic (ECG) parameters and major and minor ECG abnormalities, there is considerable controversy regarding their age and gender differences in the literature.MethodsData from 7630 adults aged ≥ 35 from the Tehran Cohort Study registered between March 2016 and March 2019 were collected. Basic ECG parameters values and abnormalities related to arrhythmia, defined according to the American Heart Association definitions, were analyzed and compared between genders and four distinct age groups. The odds ratio of having any major ECG abnormality between men and women, stratified by age, was calculated.ResultsThe average age was 53.6 (± 12.66), and women made up 54.2% (n = 4132) of subjects. The average heart rate (HR) was higher among women(p < 0.0001), while the average values of QRS duration, P wave duration, and RR intervals were higher among men(p < 0.0001). Major ECG abnormalities were observed in 2.9% of the study population (right bundle branch block, left bundle branch block, and Atrial Fibrillation were the most common) and were more prevalent among men compared to women but without statistical significance (3.1% vs. 2.7% p = 0.188). Moreover, minor abnormalities were observed in 25.9% of the study population and again were more prevalent among men (36.4% vs. 17% p < 0.001). The prevalence of major ECG abnormalities was significantly higher in participants older than 65.ConclusionMajor and minor ECG abnormalities were roughly more prevalent in male subjects. In both genders, the odds of having major ECG abnormalities surge with an increase in age.

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.

Cardiac abnormalities in girls with Turner syndrome: ECG abnormalities, myocardial strain imaging, and karyotype-phenotype associations.

Turner syndrome (TS) is a chromosomal condition which is associated with an increased prevalence of cardiac morbidity and mortality. In this cross‐sectional study, Minnesota‐based electrocardiographic (ECG) abnormalities, aortic dimensions, routine‐ and myocardial strain echocardiographic parameters, and karyotype‐cardiac phenotype associations were assessed in girls with TS. In total, 101 girls with TS (0–18 years) were included. The prevalence of major ECG abnormalities was 2% (T‐wave abnormalities) and 39% had minor ECG abnormalities. Dilatation of the ascending aorta (z‐score > 2) was present in 16%, but the prevalence was much lower when using TS‐specific z‐scores. No left ventricular hypertrophy was detected and the age‐matched global longitudinal strain was reduced in only 6% of the patients. Cardiac abnormalities seemed more common in patients with a non‐mosaic 45,X karyotype compared with other karyotypes, although no statistically significant association was found. Lowering the frequency of echocardiography and ECG screening might be considered in girls with TS without cardiovascular malformations and/or risk factors for aortic dissection. Nevertheless, a large prospective study is needed to confirm our results. The appropriate z‐score for the assessment of aortic dilatation remains an important knowledge gap. The karyotype was not significantly associated with the presence of cardiac abnormalities, therefore cardiac screening should not depend on karyotype alone.

Relationship Between Sarcopenia and Electrocardiographic Abnormalities in Older People: The Bushehr Elderly Health Program.

Background: Sarcopenia is characterized by low skeletal muscle mass and function, which is associated with cardiovascular risk factors and may even be related to adverse cardiovascular events and mortality. This study aimed to evaluate whether sarcopenia is related to electrocardiographic (ECG) abnormalities in a large sample of older adults.Methods: We performed a cross-sectional study based on the data collected during the Bushehr Elderly Health (BEH) cohort study. Body composition was measured by dual X-ray absorptiometry (DXA) and muscle strength was measured using a digital dynamometer for each hand of every participant. A person who had low muscle strength, as well as low muscle mass was identified as having sarcopenia. The subjects were classified into three groups according to the Minnesota Code (MC) as major, minor ECG abnormalities and participants with no abnormalities ECG.Results: Of the 2,426 participants, 354 (14.6%) had major ECG abnormalities and 193 (8%) had minor ECG abnormalities. Sarcopenia was associated with an increased risk of major ECG abnormality in all models. After adjustment for confounders of CHD in full model, the OR for major ECG abnormality was 1.47 (95% CI 1.11–1.95) in those with sarcopenia. Low muscle strength and low muscle performance were both with an increased risk of major ECG abnormality in all models. Sarcopenia and low muscle strength increased 28% and 62% risk of any ECG abnormality in the full models [sarcopenia: 1.28(1.01–1.63), low muscle strength: 1.62(1.30–2.03)], respectively.Conclusions: This study showed that sarcopenia and its components are associated with ECG abnormalities in Iranian older people. Although some older adults have higher cardiovascular risk factors, these data showed that further factors such as sarcopenia may be identified as a particular risk factor for future cardiovascular events. Therefore, sarcopenia could be added to the screening of the older population to reduce the risk of cardiovascular events.

Prevalence of major and minor electrocardiographic abnormalities in one million primary care Latinos

This study aims to assess the prevalence of electrocardiographic abnormalities based on the Minnesota code from a large sample of 1.01 m adult Brazilian primary care patients and to evaluate its association with age, sex, and cardiovascular risk factors. A large electrocardiogram (ECG) database of such patients aged ≥18 years (mean age 52 ± 17 years-old with 60.2% female). was analyzed and the results were stratified by sex and age. The prevalence of abnormalities was more common in men and the elderly population. Major electrocardiographic abnormalities were observed in 20.2% of adults and 43.1% of elderly patients, and minor abnormalities were found in 46.0% 39.4%, respectively. For adult patients, the number and percentage of major abnormalities rise depending on the number of cardiovascular risk factors. For elderly patients, the correlation between these variables is not clear, and the percentage of major abnormalities remains stable independently of the number of risk factors.

A negative T-wave in electrocardiogram at 50 years predicted lifetime mortality in a random population-based cohort.

BackgroundSevere electrocardiographic (ECG) abnormalities in asymptomatic subjects correlate with cardiovascular risk.HypothesisThe role of minor ECG abnormalities is less well‐known. We evaluated the association between a negative T‐wave and mortality, as a possible marker for prognosis.MethodsA prospective, population‐based cohort, examined at 50 years, and followed until death. Time to death (event rates) and predictive role of a negative T‐wave (Cox regression) were analyzed.ResultsParticipants (n = 839) with a negative T‐wave (7.3%) had significantly higher blood pressure (BP) (mean systolic 157.9 mmHg vs 136.8 mmHg without negative T‐wave, P = <.0001). A negative T‐wave correlated with elevated risk (hazard ratio [HR] [95% CI] [confidence interval]) for all‐cause and cardiovascular (CV) death (1.59 (1.20‐2.11) P = .0012 vs 1.91 (1.34‐2.73) P = .0004). The association remained after excluding coexisting Q/QS patterns and ST‐junction/segment depression ECG abnormalities (1.66 [1.13‐2.44] P = .0098 for all‐cause vs 1.87 [1.13‐3.09] P = .015 for CV death). Death from other causes was not associated with a negative T‐wave. A major negative T‐wave carried higher risk than a minor (2.17 [1.25‐3.76] P = .0062 vs 1.78 [1.13‐2.79] P = .012) for CV death.ConclusionA negative T‐wave at 50 years, in asymptomatic individuals, carried an increased risk of all‐cause and CV death during lifetime follow‐up.

Exertional Rhabdomyolysis: A Retrospective Population-based Study.

This study aimed to evaluate the incidence and characteristics of exertional rhabdomyolysis (ER) in a population-based cohort. A retrospective cohort study was performed in Olmsted County, Minnesota, from 2003 to 2015. Incident ER cases were ascertained through the Rochester Epidemiology Project medical record linkage system through electronic searches of the International Classification of Diseases, Ninth Revision, codes and clinical note text. Population incidence rate was calculated using the corresponding Rochester Epidemiology Project census populations specific to calendar year and sex. Descriptive statistics were used. Of the 430 patients, 431 cases met the inclusion criteria for rhabdomyolysis; 4.9% of cases (n = 20; males n = 18; Caucasian n = 17) were ER, with one recurrence. There were no deaths secondary to ER. The age- and sex-adjusted incidence rate of ER was 1.06 ± 0.24 (95% confidence interval = 0.59-1.52) per 100,000 person-years. Endurance activity (n = 7), manual labor (n = 5), and weight lifting (n = 4) were common causes. Complications included kidney injury (n = 5), mild electrolyte abnormalities (n = 10), elevated transaminases (n = 12), and minor electrocardiographic abnormalities (n = 4). A majority of patients were hospitalized (n = 16) for a median of 2 d, had mild abnormalities in renal and liver function and electrolytes, and were discharged without sequelae. ER in the civilian population occurs at a much lower incidence than the military population. The most common causes were endurance exercise, manual labor, and weight lifting. The majority of cases were treated conservatively with intravenous fluid resuscitation during a brief hospital stay, and all were discharged without sequela. Only one case of recurrence occurred in this cohort, indicating the recurrence rate was low.

Abstract P370: Minor Electrocardiographic Abnormalities and Cardiovascular Mortality

Background: Although minor electrocardiographic (ECG) abnormalities are common in clinical practice, their prognostic significance remains unclear due to inconsistent reports. Such inconsistent reports may be related to the focus on the presence vs. absence of minor ECG abnormalities and ignoring the number of abnormalities. Hypothesis: The number of minor abnormalities is associated with cardiovascular disease (CVD) mortality in a dose-response fashion. Methods: This analysis included 6,467 participants (mean age 59 years 53% women, 49% non-Hispanic whites) from the NHANES-III who were free of CVD and major ECG abnormalities. ECG abnormalities were defined from digitally recorded and centrally processed standard 12-lead ECGs using the Minnesota Code ECG Classification. Cause of death was identified using the National Death Index. Cox proportional hazards analysis was used to examine the association between baseline minor ECG abnormalities (presence of at least 1 abnormality vs. normal ECG, and presence of 1, or ≥2 abnormalities vs. normal ECG, separately) with CVD mortality. Results: About 38% (n=2,438) of the participants had at least 1 minor abnormality at baseline. During a median follow-up of 13.9 years, 755 CVD deaths occurred. Compared to normal ECG, presence of minor ECG abnormally was marginally associated with CVD mortality (HR(95%CI):1.16 (1.00, 134); p= .0045). When the number of abnormalities was taken into account, the association with CVD mortality showed a dose-response relationship. While presence of only 1 minor abnormality was not associated with CVD mortality, presence of ≥ 2 abnormalities was associated with a 39% increased risk. Also, each additional minor ECG abnormality was associated a 13% increased risk of CVD mortality ( Table ). Conclusions: The number of minor ECG abnormalities, not only their mere presence, should be taken into account to both understand the prognostic significance of these common findings and to enhance the potential role of ECG to identify individuals at risk for CVD.

Relation of Minor Electrocardiographic Abnormalities to Cardiovascular Mortality

Although minor electrocardiographic (ECG) abnormalities are common findings in clinical practice, their prognostic significance remains unclear due to inconsistent reports. We hypothesized that this inconsistency is due to the traditional focus on examining their prognostic significance as a binary variable (i.e., presence vs absence of any abnormality) ignoring the number of abnormalities. We tested this hypothesis in 6,467 participants (mean age 59 years, 53% women) from the Third National Health and Nutrition Examination Survey who were free of baseline cardiovascular disease (CVD) and major ECG abnormalities. ECG abnormalities were defined from digitally recorded and centrally processed standard electrocardiograms using the Minnesota ECG Classification. CVD mortality was ascertained using National Death Index. About 38% of participants (n = 2,438) had at least 1 minor ECG abnormality at baseline. During a median follow-up of 13.9 years, 755 CVD deaths occurred. In a multivariable Cox model, presence of at least 1 minor ECG abnormality was marginally associated with increased risk of CVD mortality (hazard ratio (95% confidence interval):1.15(1.00,1.34), p-value = 0.04)). However, as the number of ECG abnormalities increases, the association with CVD mortality showed a dose-response relation (event rate per 1,000 person-year of 7.3, 10.1, and 16.7 in participants with 0, 1, and ≥2 ECG abnormalities, respectively; p-value for trend <0.01). Also, each additional minor ECG abnormality was associated with a 13% increased risk of CVD mortality (hazard ratio (95% confidence interval): 1.13(1.04, 1.24)). In conclusion, the number, not only the mere presence of minor ECG abnormalities should be taken into account to understand the prognostic significance of these common findings.

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.

Electrocardiographic Abnormalities and Cardiovascular Disease Risk in Type 1 Diabetes: The Epidemiology of Diabetes Interventions and Complications (EDIC) Study.

OBJECTIVEWe examined the association between the prevalence and incidence of electrocardiographic (ECG) abnormalities and the development of cardiovascular disease (CVD) in patients with type 1 diabetes, among whom these ECG abnormalities are common.RESEARCH DESIGN AND METHODSWe conducted a longitudinal cohort study involving 1,306 patients with type 1 diabetes (mean age 35.5 ± 6.9 years; 47.7% female) from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study. ECG abnormalities were defined by the Minnesota Code ECG classification as major, minor, or no abnormality. CVD events were defined as the first occurrence of myocardial infarction, stroke, confirmed angina, coronary artery revascularization, congestive heart failure, or death from any CVD.RESULTSDuring a median follow-up of 19 years, 155 participants (11.9%) developed CVD events. In multivariable Cox proportional hazard models adjusted for demographics and potential confounders, the presence of any major ECG abnormalities as a time-varying covariate was associated with a more than twofold increased risk of CVD events (hazard ratio [HR] 2.10 [95% CI 1.26, 3.48] vs. no abnormality/normal ECG, and 2.19 [1.46, 3.29] vs. no major abnormality). Also, each visit (year) at which the diagnosis of major ECG abnormality was retained was associated with a 30% increased risk of CVD (HR 1.30 [95% CI 1.14, 1.48]). The presence of minor ECG abnormalities was not associated with a significant increase in CVD risk.CONCLUSIONSThe presence of major ECG abnormalities is associated with an increased risk of CVD in patients with type 1 diabetes. This suggests a potential role for ECG screening in patients with type 1 diabetes to identify individuals at risk for CVD.

Abstract P117: Mexican Reg i stry of Risk Factors for Cerebrovascular Disease: The “RISK” (RIESGO) Study, a Mexican Approach

Background: The RIESGO (RISK) study was established to investigate associations between lifestyle, risk factors and cerebrovascular diseases in 300 attendees to the annual meeting of the Mexican Academy of Neurology. In these analyses we describe traditional and several new risk factors for Cerebrovascular Disease on the RIESGO participants as well as a novel way to create a cohort. Methods: The RIESGO study employed a sample of the Mexican Congress of neurology attendees and intends to follow them prospectively. All attendees were invited to participate (n=1300). A survey on lifestyle questions, and clinical evaluations were conducted at the congress site, non-parametric descriptive statistics were used. Results: 300 attendees (68.8% physicians) participated in RIESGO, 18-83 years old mean 47.1(DE=13.9) and 59% were men. In the RIESGO study, self-reported Diabetes (DM) was 6.8% compared to 20.1% using Glycated Hemoglobin (HbA1c) for diagnosis (&gt;6.5%) and 40% of those with self-reported DM had elevated HbA1c. Also remarkable is the 20.3% major and minor electrocardiographic abnormalities. Systolic and diastolic hypertension was observed in 14.1% and 4.1% respectively, vs 18.4% for self-reported hypertension. Obesity and overweight was observed 66.2% based on BMI &gt; 25kg/m2. Active and former smoking rates were 14.3% and 24.4% respectively, active exercise (&gt;150min/week) was reported in 48.5% and high alcohol consumption (&gt;25 12Oz Beer or equivalent/30days) was 19.9%. The subclinical outcomes were: intima-media thickness (≥0.8mm) found in 2.3%, carotid plaque in 6% and ventricular hypertrophy (Sokolow) in 1.8%. We also explored other new risk factors associated with stroke, and found a high heart rate at rest (&gt;70 beats per minute) in 35%, ventricular premature beats 1.1%, prolonged QTc 0.6% and 0% in men and women respectively, finally on the perceived stress scale 97% “never” or “almost never” felt stressed and only 2.3% felt “fairly often stressed”. We will also discuss the association of traditional vs newer risk factors with subclinical outcomes. Conclusions: These findings indicate a high prevalence and poor awareness and control of major cardiovascular disease risk factors and subclinical outcomes, despite the fact that RIESGO participants have a substantially higher education level and health information than the general Mexican population. These findings reflect the alarming public health problems that diabetes and cardiovascular diseases represent in the Mexican population, even among the most educated individuals. Recurrent attendance at the annual meeting is a novel and convenient way to establish a low cost follow-up study.

Cardiovascular risk prediction: Can Systematic Coronary Risk Evaluation (SCORE) be improved by adding simple risk markers? Results from the Copenhagen City Heart Study.

European society of cardiology (ESC) guidelines recommend that cardiovascular disease (CVD) risk stratification in asymptomatic individuals is based on the Systematic Coronary Risk Evaluation (SCORE) algorithm, which estimates individual 10-year risk of death from CVD. We assessed the potential improvement in CVD risk stratification of 19 easily available risk markers by adding them to the SCORE algorithm. We followed 8476 individuals without prior CVD or diabetes from the Copenhagen City Heart study. The 19 risk markers were: major and minor electrocardiographic (ECG) abnormalities, heart rate, family history (of ischaemic heart disease), body mass index (BMI), waist-hip ratio, walking duration and pace, leisure time physical activity, forced expiratory volume (FEV)1%pred, household income, education, vital exhaustion, high-density lipoprotein (HDL) cholesterol, triglycerides, apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), high-sensitive C-reactive protein (hsCRP) and fibrinogen. With the exception of family history, BMI, triglycerides and minor ECG changes, all risk markers remained significantly associated with CVD mortality after adjustment for SCORE variables. However, the addition of the remaining 15 risk markers resulted in only small changes in discrimination calculated by area under the curve (AUC) and integrated discrimination improvement (IDI) and no improvement in net reclassification improvement (NRI). HsCRP improved AUC by 0.006 (p = 0.015) and IDI by 0.012 (p = 0.002); FEV1%pred improved AUC by 0.006 (p = 0.032) and IDI by 0.006 (p = 0.029). In the intermediate risk group FEV1%pred, education, vital exhaustion and ApoA1 all improved NRI but FEV1%pred was the only risk marker to significantly improve both IDI, AUC and NRI. The SCORE algorithm predicted CVD mortality in a Danish cohort well. Despite strong association with CVD mortality, the individual addition of 19 easily available risk makers to the SCORE model resulted in small risk stratification improvements.

Prevalence of electrocardiographic abnormalities based on hypertension severity and blood pressure levels: the Reasons for Geographic and Racial Differences in Stroke study

We evaluated the prevalence of major and minor electrocardiographic (ECG) abnormalities based on blood pressure (BP) control and hypertension (HTN) treatment resistance. We analyzed data from the Reasons for Geographic and Racial Differences in Stroke study of 20,932 participants who were divided into presence of major (n = 3782), only minor (n = 8944), or no (n = 8206) ECG abnormalities. The cohort was stratified into normotension (n = 3373), pre-HTN (n = 4142), controlled HTN (n = 8619), uncontrolled HTN (n = 3544), controlled apparent treatment-resistant HTN (aTRH, n = 400), and uncontrolled aTRH (n = 854) groups, and the prevalence ratios (PRs) of major and minor ECG abnormalities were assessed separately for each BP group. The full multivariable adjustment included demographics, risk factors, and HTN duration. Compared with normotension, the PRs of major ECG abnormalities for pre-HTN, controlled HTN, uncontrolled HTN, controlled aTRH, and uncontrolled aTRH groups were 1.01 (0.90–1.14), 1.30 (1.16–1.45), 1.37 (1.23–1.54), 1.42 (1.22–1.64), and 1.44 (1.26–1.65), respectively (P < .001), whereas the PRs of minor ECG abnormalities among each of the above BP groups were similar. Detection of major ECG abnormalities among hypertensive persons with poor control and treatment resistance may help improve their cardiovascular risk stratification and early intervention.

Association of Traditional Cardiovascular Risk Factors With Development of Major and Minor Electrocardiographic Abnormalities: A Systematic Review.

Electrocardiographic (ECG) abnormalities are prevalent in middle aged and are associated with risk of adverse cardiovascular events. It is unclear whether and to what extent traditional risk factors are associated with the development of ECG abnormalities. To determine whether traditional cardiovascular risk factors are associated with the presence or development of ECG abnormalities, we performed a systematic review of the English-language literature for cross-sectional and prospective studies examining associations between traditional cardiovascular risk factors and ECG abnormalities, including major and minor ECG abnormalities, isolated nonspecific ST-segment and T-wave abnormalities, other ST-segment and T-wave abnormalities, QT interval, Q waves, and QRS duration. Of the 202 papers initially identified, 19 were eligible for inclusion. We examined data analyzing risk factor associations with ECG abnormalities in individuals free of cardiovascular disease. For composite major or minor ECG abnormalities, black race, older age, higher blood pressure, use of antihypertensive medications, higher body mass index, diabetes, smoking, and evidence of left ventricular hypertrophy or higher left ventricular mass are the factors most commonly associated with prevalence and incidence. Risk factor associations differ somewhat according to types of specific ECG abnormalities. Because major and minor ECG abnormalities have important and independent prognostic significance, understanding the groups at risk for their development may inform prevention strategies focused on modifiable risk factors to reduce the burden of ECG abnormalities, which may in turn promote CVD prevention.

Electrocardiographic changes in adults living in a southern Brazilian city: A population-based studyElectrocardiographic changes in adults living in a southern Brazilian city: A population-based study

Introduction and ObjectivesAbnormalities on the resting electrocardiogram (ECG) are predictors of mortality and cardiovascular events among asymptomatic adults. The aim of this study was to estimate the prevalence of ECG abnormalities in adults and their association with cardiovascular risk factors. MethodsWe performed a cross-sectional analysis of ECGs in adults aged 19–59 years, living in Tubarão, Santa Catarina, Brazil. Data were collected between November 2011 and July 2012. Electrocardiographic findings were classified according to the guidelines of the Brazilian Society of Cardiology on analyzing and issuing electrocardiographic reports, and were divided into major abnormalities, minor abnormalities and no changes, as in previous studies. Pearson's chi-square test and ANOVA were used to analyze the association of ECG parameters with traditional cardiovascular risk factors. ResultsA total of 361 participants were studied. Mean age was 40.4±12.2 years; 232 (64.3%) were women. Minor abnormalities were found in 16.9% and major abnormalities in 3.3%. Among the risk factors examined, gender, smoking, alcohol consumption, systemic hypertension, diabetes, and high Framingham risk score were significantly associated with major and minor ECG changes. ConclusionsThe prevalence of electrocardiographic changes was 20.2% in the population surveyed, the majority being minor. Both major and minor electrocardiographic abnormalities showed significant associations with risk of coronary artery disease, and may predict cardiovascular risk in asymptomatic adults.

Alterações eletrocardiográficas na população adulta de cidade do sul do Brasil: estudo populacional

Introduction and ObjectivesAbnormalities on the resting electrocardiogram (ECG) are predictors of mortality and cardiovascular events among asymptomatic adults. The aim of this study was to estimate the prevalence of ECG abnormalities in adults and their association with cardiovascular risk factors. MethodsWe performed a cross‐sectional analysis of ECGs in adults aged 19‐59 years, living in Tubarão, Santa Catarina, Brazil. Data were collected between November 2011 and July 2012. Electrocardiographic findings were classified according to the guidelines of the Brazilian Society of Cardiology on analyzing and issuing electrocardiographic reports, and were divided into major abnormalities, minor abnormalities and no changes, as in previous studies. Pearson's chi‐square test and ANOVA were used to analyze the association of ECG parameters with traditional cardiovascular risk factors. ResultsA total of 361 participants were studied. Mean age was 40.4±12.2 years; 232 (64.3%) were women. Minor abnormalities were found in 16.9% and major abnormalities in 3.3%. Among the risk factors examined, gender, smoking, alcohol consumption, systemic hypertension, diabetes, and high Framingham risk score were significantly associated with major and minor ECG changes. ConclusionsThe prevalence of electrocardiographic changes was 20.2% in the population surveyed, the majority being minor. Both major and minor electrocardiographic abnormalities showed significant associations with risk of coronary artery disease, and may predict cardiovascular risk in asymptomatic adults.

Nursing experiences of caring for burns patience with sepsis in critical care unit in South West Nigeria (case study NOHI LAGOS)

Unless effective preventive strategies are implemented, aging of the population will result in a significant worsening of the heart failure (HF) epidemic. Few data exist on whether baseline electrocardiographic (ECG) abnormalities can refine risk prediction for HF.We examined a prospective cohort of 2,915 participants aged 70 to 79 years without preexisting HF, enrolled between April 1997 and June 1998 in the Health, Aging, and Body Composition (Health ABC) study. Minnesota Code was used to define major and minor ECG abnormalities at baseline and at year 4 follow-up. Using Cox models, we assessed (1) the association between ECG abnormalities and incident HF and (2) the incremental value of adding ECG to the Health ABC HF Risk Score using the net reclassification index.At baseline, 380 participants (13.0%) had minor, and 620 (21.3%) had major ECG abnormalities. During a median follow-up of 11.4 years, 485 participants (16.6%) developed incident HF. After adjusting for the Health ABC HF Risk Score variables, the hazard ratio (HR) was 1.27 (95% CI 0.96-1.68) for minor and 1.99 (95% CI 1.61-2.44) for major ECG abnormalities. At year 4, 263 participants developed new and 549 had persistent abnormalities; both were associated with increased subsequent HF risk (HR 1.94, 95% CI 1.38-2.72 for new and HR 2.35, 95% CI 1.82-3.02 for persistent ECG abnormalities). Baseline ECG correctly reclassified 10.5% of patients with HF events, 0.8% of those without HF events, and 1.4% of the overall population. The net reclassification index across the Health ABC HF risk categories was 0.11 (95% CI 0.03-0.19).Among older adults, baseline and new ECG abnormalities are independently associated with increased risk of HF. The contribution of ECG screening for targeted prevention of HF should be evaluated in clinical trials.