Prevalence Of ECG Abnormalities Research Articles

ECG Abnormalities in Patients with Acute Exacerbation of Bronchiectasis and Factors Associated with High Probability of Abnormality.

Background Bronchiectasis is an important reason for morbidity and mortality according to the last records that referred to high incidence rate of disease. Cardiovascular problems are common in pulmonary diseases, in general, and it can symptom by ECG abnormalities. The objective of this study was to define the most ECG abnormalities in patients with acute exacerbation of bronchiectasis and to study the correlation between the cardiac disorder and the other risk factors of the exacerbation. Materials and Methods A prospective single-center observational cohort study was done at Aleppo University Hospital for patients with AEB between October 2017 and September 2018. They were divided into 2 groups (normal ECG vs. abnormal). Patients with COPD, cystic fibrosis, new diagnosis of ischemic accident through the last 6 months of the study, and treatment with macrolides or fluoroquinolones through the last 3 months of the study were excluded. We study the percent of abnormalities through the AEB and the percentage of the most common abnormalities. Results 67 patients were included in the study (44 males and 23 females) with a mean age of 52.85 ± 21.456. ECG abnormalities were recorded in 43 patients, and it was more common in men (67.44% of cases). Advanced age and survival state had a statistical significance (p = 0.003, 0.023), respectively, between the 2 groups. Right axis deviation (RAD) is the most common abnormality (23.3%) followed by sinus tachycardia (20.9%), and it is close to T-depression (18.6%). AF was the most common arrhythmia from all recorded arrhythmias (6.98% from all cases). Positive sputum cultures were recorded in 55.8%, and the most common isolated pathogen factor was Pseudomonas aeruginosa. Recurrent pneumonia was seen in 30.2% of all patients with abnormal ECG. We find a high prevalence of ECG abnormalities in patients with Oximetry (90-95%, 39.5%), and the opportunity for abnormalities is equal in the 2 age groups (45–59 and more than 75) that reflexed the possibility of cardiac disorders in any age in patients with AEB. Conclusions ECG abnormalities are common in AEB, and it can happen in any age and any value of Oximetry. It needs more attention because of the prognosis of the cardiac morbidity.

Study of electrocardiographic changes in patients with acute cerebrovascular accidents

Background: Stroke is “a focal (or at times global) neurological impairment of sudden onset, and lasting more than 24 hours (or leading to death), and of presumed vascular origin. A variety of cardiovascular events like cardiac arrest, arrhythmias, and severe hypotension can be seen in stroke victims. The purpose of this study is to investigate the prevalence and characterization of ECG abnormalities in patients of cerebrovascular accidents.Methods: Study was carried out in Dr. PDMMC and tertiary care hospital Amravati, Maharashtra, India. All acute cerebrovascular accidents patients were the study subjects. The diagnosis of ischemic stroke was confirmed by CT scanning. Pre-validated questionnaire was used for data collection. At the end of the study all the ECG were compared to approach towards the result. Study was carried out over a period of three months from October to December 2020.Results: We have recruited 90 stroke patients, most of them were males. Major type was ischemic stroke. In total 62 (68.89%) stroke patients had some form of ECG change. Majority i.e. 35 (38.89%) patients had QTc prolongation followed by 32 (35.56%) patients had T wave changes. QTc prolongation and Atrial fibrillation were significantly more among hemorrhagic stroke patients (p<0.05) and T wave changes and ST changes (elevation or depression) were significantly more among ischemic stroke patients (p<0.05).Conclusions: Prevalence of ECG abnormalities among stroke patients was more i.e. 68.89%. QTc prolongation and T wave changes were the commonest ECG abnormalities.

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.

ECG modifications, life-threatening ventricular arrhythmias and relation to mitral valve apparatus phenotype in mitral valve prolapse

Abstract Background Mitral valve prolapse (MVP) is a common condition in the general population, which can be associated to non-specific ECG abnormalities described initially as ST segment depression, T waves flattening or inversion, especially in the inferior leads. Lately, this type of ECG abnormalities has been reported in patients with MVP and ventricular arrhythmias (VA) or sudden death (SD). However, the prevalence of ECG abnormalities has never been studied in a large series of patients, and the link between ECG abnormalities, VA and SD to echocardiography examination has never been prospectively assessed. Objective To study the prevalence of ECG abnormalities including ventricular arrhythmias in MVP patients and their link with echocardiographic characteristics. Methods All patients (n=731, MVP = 486, Controls = 245) were prospectively enrolled and underwent a comprehensive echocardiography and ECG. In MVP patients 81 had minimal systolic displacement (MSD), 92 isolated MVP, 108 mild-moderate MR, and 196 severe MR. A comprehensive qualitative and quantitative analysis of ECG obtained from rest ECG, 24-hours ECG recording or exercise stress tests, was carried out. Mean follow-up was 4.4 years. Results The mains ECG abnormalities were an inversion of T wave in the inferior leads found in 12 MVP vs 1 control (2.5 vs 0.4%, P=0.047) or a QRS notch (5.1 vs 2.9%, P=0.13). In bileaflet MVP T wave inversion was more frequent as compared with other MVP patients (3.8 vs 0.8%, P=0.039). In addition there was a progressive prolongation of PR interval, QRS duration and increase QT dispersion associated with worsening of MR and heart chambers remodeling. None of ECG findings were significantly linked with the presence of MVP only. Out of 731 individuals, 27 (3.7%) had an history of VA or SD. In a multivariate analysis, bileaflet prolapse and mitral annulus disjunction were associated with VA or SD, whereas none of ECG criterion was associated with. Conclusion In this large prospective series of MVP patients, prevalence of inferior leads ECG abnormalities is very low. Prolongation of atrio-ventricular and ventricular conduction, as well increased QT dispersion is associated with worsening of MR and LV remodeling. Bileaflet prolapse and mitral annulus disjunction are associated with VA or SD. Funding Acknowledgement Type of funding source: None

Electrocardiographic characteristics in patients with heart failure and normal ejection fraction: A systematic review and meta-analysis.

BackgroundLittle is known about ECG abnormalities in patients with heart failure and normal ejection fraction (HeFNEF) and how they relate to different etiologies or outcomes.Methods and ResultsWe searched the literature for peer‐reviewed studies describing ECG abnormalities in HeFNEF other than heart rhythm alone. Thirty five studies were identified and 32,006 participants. ECG abnormalities reported in patients with HeFNEF include atrial fibrillation (prevalence 12%–46%), long PR interval (11%–20%), left ventricular hypertrophy (LVH, 10%–30%), pathological Q waves (11%–18%), RBBB (6%–16%), LBBB (0%–8%), and long JTc (3%–4%). Atrial fibrillation is more common in patients with HeFNEF compared to those with heart failure and reduced ejection fraction (HeFREF). In contrast, long PR interval, LVH, Q waves, LBBB, and long JTc are more common in patients with HeFREF. A pooled effect estimate analysis showed that QRS duration ≥120 ms, although uncommon (13%–19%), is associated with worse outcomes in patients with HeFNEF.ConclusionsThere is high variability in the prevalence of ECG abnormalities in patients with HeFNEF. Atrial fibrillation is more common in patients with HeFNEF compared to those with HeFREF. QRS duration ≥120 ms is associated with worse outcomes in patients with HeFNEF. Further studies are needed to address whether ECG abnormalities correlate with different phenotypes in HeFNEF.

P2732Prevalence of electrocardiographic abnormalities in patients with cardiac amyloidosis

Abstract Background Electrocardiographic (ECG) abnormalities are common in patients presenting with Light-Chain (AL) or Transthyretin (ATTR) related Cardiac Amyloidosis (CA). Type of amyloid may differently affect electrical properties of the heart being responsible for variable patterns of ECG anomalies at presentation. Purpose In this retrospective, observational study we sought to compare prevalence of ECG abnormalities between AL and ATTR patients with CA. Methods Clinical files from two Referral Centres were reviewed; ECG recordings were analysed by trained cardiologists and relevant findings were reported about rhythm (sinus vs atrial fibrillation [AF]), grade I or grade II atrio-ventricular (AV) delays, intra-ventricular (IV) conduction abnormalities, low-voltage QRS and pseudo-necrosis pattern. Presence of pace-maker (PM) and stimulated QRS were regarded to as clinical equivalents for AV block, after review of indications to implantation. Results Two hundred and fifty-one patients were identified (127 ATTR vs 124 AL; among ATTR, 27 patients had mutation in TTR gene: 10 Val142Ile, 11 Ile88Leu, 6 other). As expected, most ATTR patients were male (89% vs 56% in AL, p: <0.001), and AL patients were younger (mean age 64 [53–70] vs 79 [73–83]; p: <0.001). Pathological ECG findings were common in both subgroups, involving more than three-quarters of the overall population (82% in ATTR, vs 72% in AL, p: 0.06). Atrial fibrillation was more common in ATTR, prevailing in 39% vs 5.6% (p: <0.001). ATTR had a higher burden of AV block (53% vs 13%, p: <0.001) and IV conduction delays (43% vs 21%, p: <0.001), and consistently presented a higher prevalence of PMs (24 patients vs 1). Low-voltage QRS was more prevalent in AL patients (52% vs 28%, p: <0.001), while no significant difference was found in prevalence of pseudo-necrosis patterns (ATTR: 29%, AL: 40%; p: ns). Due to imbalance in age and gender and relative possible confounding effect on rhythm disturbances, adjusted odds ratios (OR) were calculated. It resulted that ATTR was independently associated with a higher prevalence of AF and AV conduction delays when compared to AL (adjusted OR: 4 [95% CI: 1.4–11.2], p: 0.008, and 6.2 [95% CI: 2.6–14.9], p: <0.001; respectively), while being inversely associated with low-voltage QRS (adjusted OR: 0.4 [95% CI: 0.2–0.9], p: 0.026). Conclusions ECG abnormalities are common in CA. Rhythm disturbances are more prevalent in ATTR, while AL more often results in low-voltage QRS. Such differences remain relevant after adjustment for age and gender imbalance, thus suggesting an aetiology-specific link.

Prevalence of ECG Abnormalities during Routine Preoperative Evaluation-A Retrospective Single Institute Study

Prevalence of ECG Abnormalities during Routine Preoperative Evaluation-A Retrospective Single Institute Study

Electrocardiographic abnormalities in Chagas disease in the general population: A systematic review and meta-analysis.

BackgroundChagas disease (CD) is a major public health concern in Latin America and a potentially serious emerging threat in non-endemic countries. Although the association between CD and cardiac abnormalities is widely reported, study design diversity, sample size and quality challenge the information, calling for its update and synthesis, which would be very useful and relevant for physicians in non-endemic countries where health care implications of CD are real and neglected. We performed to systematically review and meta-analyze population-based studies that compared prevalence of overall and specific ECG abnormalities between CD and non-CD participants in the general population.MethodsSix databases (EMBASE, Ovid Medline, Web of Science, Cochrane Central, Google Scholar and Lilacs) were searched systematically. Observational studies were included. Odds ratios (OR) were computed using random-effects model.ResultsForty-nine studies were selected, including 34,023(12,276 CD and 21,747 non-CD). Prevalence of overall ECG abnormalities was higher in participants with CD (40.1%; 95%CIs=39.2-41.0) compared to non-CD (24.1%; 95%CIs=23.5-24.7) (OR=2.78; 95%CIs=2.37-3.26). Among specific ECG abnormalities, prevalence of complete right bundle branch block (RBBB) (OR=4.60; 95%CIs=2.97-7.11), left anterior fascicular block (LAFB) (OR=1.60; 95%CIs=1.21-2.13), combination of complete RBBB/LAFB (OR=3.34; 95%CIs=1.76-6.35), first-degree atrioventricular block (A-V B) (OR=1.71; 95%CIs=1.25-2.33), atrial fibrillation (AF) or flutter (OR=2.11; 95%CIs=1.40-3.19) and ventricular extrasystoles (VE) (OR=1.62; 95%CIs=1.14-2.30) was higher in CD compared to non-CD participants.ConclusionsThis systematic review and meta-analysis provides an update and synthesis in this field. This research of observational studies indicates a significant excess in prevalence of ECG abnormalities (40.1%) related to T. cruzi infection in the general population from Chagas endemic regions, being the most common ventricular (RBBB and LAFB), and A-V B (first-degree) node conduction abnormalities as well as arrhythmias (AF or flutter and VE). Also, prevalence of ECG alterations in children was similar to that in adults and suggests earlier onset of cardiac disease.

Pattern of Electrocardiographic Changes in Pre-operative check-up in Patients Undergoing ENT Surgery

Background: The 12-lead ECG is the primary clinical tool for non-invasive assessment of cardiac electrical function. Before any surgery, ECG is commonly used in pre-operative check-up. Therefore pre-operative check-up of large number of people can be a valuable tool for accurate estimates of the prevalence of ECG abnormalities of general population. Objectives: To observe the extent of ECG changes in a group of population undergoing ENT surgery and to describe the prevalence of changes in relation to age and sex. Methods: 704 consecutive adult stable patients were included between age of 20 – 60 years without previously diagnosed case of any other systemic diseases who came to this hospital for elective surgical procedures and were investigated with new ECG for pre-operative check-up in private Hospital between January 201 to December 2010. Results: Total number of ECG recordings were 704; out of them 479 were male & 225 were female. Among 704 ECG recording 486(69.03%) were normal. The number of old myocardial infarction (MI) was in 36 cases (5.11%). Cardiac Ischaemia observed by ST depressions/T inversion was present in 15 cases (2.13%). Conclusion: The observation of the study is concludes that nearly 70% of all asymptomatic people (between 20 – 60 years) possessing normal ECG but Ischaemic changes (like Q wave/ST depression & T inversion/ LBBB) was present in about 8% cases. ECG changes of IHD (Ischaemic Heart Disease) increases with age and male groups at higher risk of developing IHD. Key Words: ECG; Pre-operative Check-up; Myocardial Infarction (MI). DOI: http://dx.doi.org/10.3329/bsmmuj.v4i2.8630 BSMMU J 2011; 4(2):56-59

Reconciling the Protean Manifestations of Arrhythmogenic Cardiomyopathy

Medical conception of a disease begins with in vivo observation and develops with recognition of cognate findings on gross anatomy, histology, and cellular pathology. It was histopathology that established myocyte disarray as the cardinal feature of hypertrophic cardiomyopathy, present even in cases where left ventricular (LV) hypertrophy is subtle or absent. To this day, clinical-pathological association retains its historical value as the primary means of gaining insight into underlying disease processes. Enhancing its appeal is its accessibility to physicians, most of whom are familiar with histopathology from medical school and attuned to visual diagnosis. Article see p 632 With the advent of molecular genetics, however, the limitations of clinical-pathological association have become apparent and nowhere more so than in the inherited arrhythmia syndromes. In the long-QT and Brugada syndromes and catecholaminergic polymorphic ventricular tachycardia, a structurally normal heart belies the propensity to ventricular arrhythmia and sudden cardiac death (SCD). How this might be possible began to unravel with the isolation of mutations in genes encoding ion channels, transporters, and binding proteins. Genetic studies also have provided fresh insights into diseases with an obvious pathological substrate, such as hypertrophic cardiomyopathy, in which sarcomeric mutations predominate. Families with a high incidence of SCD and myocyte disarray but minimal LV hypertrophy were found to have mutations in troponin T,1 lending further support to the inclusion of this phenotype within the spectrum of hypertrophic cardiomyopathy. Redefining diseases according to their genetic etiology, while attractive, is less straightforward than immediately obvious. Defects in sarcomeric components, for example, have been implicated in both hypertrophic cardiomyopathy and dilated cardiomyopathy. In some heritable disorders, such as dilated cardiomyopathy, marked locus heterogeneity precludes delineation of a single genetic determinant. The ultimate solution to disease classification involves going 1 step further and identifying a unifying molecular mechanism, which may …

Serum insulin and ECG abnormalities suggesting coronary heart disease in the populations of Mauritius and Nauru: Cross-sectional and longitudinal associations

Cross-sectional associations between insulin and ECG abnormalities suggestive of ‘possible’ and ‘probable’ coronary heart disease (CHD) in the populations of Nauru ( n = 568) and Mauritius ( n = 3280) have been examined in both non-diabetic and diabetic subjects. Additionally, the longitudinal relationship between baseline insulin and incident ECG abnormalities has been explored in non-diabetic Nauruans ( n = 177) over 5 years. Age-adjusted mean 2-hour serum insulin was generally higher in subjects with ECG abnormalities than those with a normal ECG, but the difference was significant only for non-diabetic Mauritian men ( p < 0.01). There was no clear association between prevalence of ECG abnormalities and quintiles of fasting or 2-hr insulin in Mauritians, and in non-diabetic Nauruans there was a non-significant positive association between prevalence of ECG abnormalities and tertiles of 2-hr insulin. Logistic regression analyses showed a slight positive association between 2-hr insulin and ECG abnormalities in non-diabetic Mauritians ( p = 0.06 in males, p = 0.09 in females), and non-diabetic male Nauruans ( p = 0.054) independent of possible confounders. Fasting insulin was not associated in any group. In longitudinal analyses in Nauruans there were no significant differences in mean baseline fasting or 2-hr serum insulin between subjects who maintained a normal ECG and those who developed abnormalities consistent with ‘possible CHD’ (there were no changes suggestive of ‘probable CHD’). The incidence of ECG changes suggesting ‘possible CHD’ was slightly higher in the upper tertile of baseline fasting insulin in both sexes and 2-hr insulin in females, but when other factors were accounted for, multiple logistic regression analyses did not support this finding. Data from the populations of Mauritius and Nauru do not support a major role for serum insulin in ECG abnormalities suggestive of CHD.

Insulin treatment, endogenous insulin concentration, and ECG abnormalities in diabetic Pima Indians. Cross-sectional and prospective analyses.

The prevalence and incidence of CHD, defined by ECG abnormalities according to the Tecumseh criteria for Minnesota Codes, were determined in Pima Indians greater than or equal to 25 yr of age. In a cross-sectional analysis, the age-sex-adjusted prevalence (+/- SE) of ECG abnormalities was higher in 1454 NIDDM patients (6.86 +/- 0.65%) than in 1696 nondiabetic subjects (3.23 +/- 0.63%; prevalence rate ratio = 2.12; 95% CI 1.39-3.25). In a prospective analysis, the age-sex-adjusted incidence (+/- SE) of ECG abnormalities was higher in 824 NIDDM patients (12.77 +/- 1.67) than in 935 nondiabetic subjects (5.93 +/- 1.43 cases/1000 person-yr; incidence rate ratio = 2.15; 95% CI 1.26-3.69). The prevalence of ECG abnormalities in insulin-treated NIDDM patients was significantly higher than in NIDDM patients not treated with insulin (age-sex-adjusted OR = 2.83; 95% CI 1.84-4.33); and this association persisted when adjusted for other factors such as sBP, BMI, duration of diabetes, serum cholesterol concentration, and oral hypoglycemic agents (OR = 2.12; 95% CI 1.34-3.37). In the prospective analysis, the incidence of ECG abnormalities in NIDDM patients treated with insulin was higher than in those NIDDM patients not treated with insulin, but, when controlled for age, sex, duration of diabetes, and oral hypoglycemic agents in a proportional-hazards model, the relationship with insulin treatment was not statistically significant (incidence rate ratio = 1.36; 95% CI 0.80-2.31). This suggests that insulin treatment may be a marker of more severe diabetes, and that factors associated with clinical indications for insulin treatment, rather than insulin treatment per se, are related causally to CHD. On the other hand, endogenous fasting and 2-h postload serum insulin concentrations were not associated with ECG abnormalities among 761 NIDDM patients not treated with insulin nor among 1226 nondiabetic subjects. Furthermore, in the prospective study, neither endogenous fasting nor 2-h postload serum insulin was associated with the subsequent development of ECG abnormalities in NIDDM patients or nondiabetic subjects.

Electrocardiographic findings in patients with hypertrophic cardiomyopathy: Relation to presenting features and prognosis

The relation of ECG findings to presenting features and prognosis was evaluated in 125 consecutive patients with hypertrophic cardiomyopathy (HC). Seventy-nine men and 46 women (mean age, 34 ± 7 years) were studied since 1970. Most ECG features were similar in patients with and without a left ventricular outflow tract gradient. Those with obstruction had a higher prevalence of left ventricular hypertrophy according to ECG voltage criteria (54% vs. 28%, p < 0.01), whereas higher grade ventricular arrhythmias were more common in patients without an outflow gradient (20% vs. 7%, p < 0.05). The prevalence of ECG abnormalities was also similar in younger (≤ 14 years) and older patients (> 14 years), and only repolarization abnormalities were more frequently detected in the older age group (56% vs. 32%, p < 0.025). Stratification of patients according to the clinical state revealed that those who had moderate to severe functional limitation had a higher prevalence of atrial fibrillation than asymptomatic or mildly symptomatic patients (24% vs. 1%, p < 0.001). There were no significant differences in most hemodynamic variables among patients dichotomized according to any specific ECG abnormality. Only patients with atrial fibrillation had significantly higher right ventricular endiastolic pressure (10 ± 7 vs. 6 ± 4 mmHg, p < 0.01), lower systolic index (22 ± 8 vs. 37 ± 15 ml/m 2; beat, p < 0.02) and lower ejection fraction (53 ± 8 vs. 64 ± 10%, p < 0.001) than those in sinus rhythm. During follow-up study, 28 patients (5 with obstruction and 23 without) died from a cardiac cause. Univariate analysis of ECG data between survivors and nonsurvivors disclosed that patients who subsequently died had, at time of diagnosis, higher frequencies of atrial fibrillation (22% vs. 4%, p = 0.0102), atrioventricular conduction delay (21% vs. 3%, p = 0.0222), intraventricular conduction delay (36% vs. 15%, p = 0.0333), and complex ventricular arrhythmias (32% vs. 15%, p = 0.0293). Multivariate analysis, however, failed to identify independent ECG risk factors for death. We conclude that some ECG findings seem to be helpful in identifying patients with HC who present a left ventricular outflow tract gradient, an older age, a more symptomatic condition, and a worse hemodynamic state at time of diagnosis. In addition, the data suggest that 12-lead ECG might improve risk factor characterization in patients with HC, since complex ventricular arrhythmias as well as atrial fibrillation and conduction delay were significantly associated with a poor outcome.

Trypanosoma Cruzi Infection and Electrocardiographic Findings among Active Manual Workers. A Population-Based Study in Central Brazil

In a cross sectional survey of the prevalence of Trypanosoma cruzi infection among urban unskilled workers in Goiânia, Brazil, blood samples from 6222 manual workers from seven institutions were examined for anti-Trypanosoma cruzi antibodies by immunofluorescence, ELISA and haemagglutination tests. ECGs were performed and a clinical history was taken from 624 seropositive and a random sample of 529 seronegative subjects. Abnormal ECGs were found in 15.1% of individuals without Trypanosoma cruzi antibodies and in 44.4% of those with antibodies (p less than 0.001). In general, cardiovascular symptoms reported were not associated with seropositivity nor with ECG alterations but dizziness and dyspnoea were more often reported among those with an abnormal tracing (p less than 0.01). The prevalence of ECG abnormalities increased with age in both groups but was higher among those seropositive in all age groups. An odds ratio of 2.0 (95% Cl 1.2-3.1) and 2.9 (95% Cl 1.5-6.3) of ECG abnormalities, for each decade of life, was estimated for seropositive and seronegative subjects, respectively. Relative risks (based on the odds ratios) for various specific ECG abnormalities, comparing seropositive to seronegative individuals, were calculated after adjustment for age, sex and institution. The odds ratio for complete right bundle branch block was 49.9 (95% CL 12.2-203.4); for left anterior hemiblock was 4.1 (2.8-6.0); for large Q/QS waves was 4.2 (2.4-7.3) and for first degree A-V block was 8.5 (2.6-28.1).

Prevalence of ischaemic ECG abnormalities according to the diabetes status in the population of Fiji and their associations with other risk factors

The prevalence of ECG abnormalities indicating the presence of coronary heart disease was examined in the Melanesian (444 men and 457 women) and Asian Indian (408 men and 435 women) population living in Fiji. The aim of the present analysis was to determine the levels of coronary risk factors in people with diabetes, impaired glucose tolerance (IGT) or normal glucose tolerance. The prevalence of ECG abnormalities suggesting coronary heart disease (Q-waves, ST-depression or T-wave changes) was higher among women than men and among Asian Indians than Melanesians. The prevalence of ECG abnormalities was highest in diabetic subjects, intermediate in people with IGT and lowest in people who had normal glucose tolerance. People with IGT were more likely than others to have high risk factor levels. In people with IGT the increased levels of other coronary risk factors might explain a great deal of the increased prevalence of the ECG abnormalities as compared with the prevalence in those with normal glucose tolerance. Also in diabetic subjects, the levels of other coronary risk factors were increased in those who had ECG abnormalities, but not more than was the case with IGT, so that diabetes itself seemed to remain as the major identified risk factor for ECG abnormalities. The prevalence of diabetes in our study populations, especially in Asian Indians, was very high. This suggests that diabetes is the major risk factor for coronary heart disease in such populations.

Electrocardiographic findings in subarachnoid hemorrhage. A population study.

The prevalence of ECG abnormalities and their prognostic value in subarachnoid hemorrhage (SAH) were analysed in patients from an epidemiological study on SAH. The analysis was based on ECGs recorded during the first 72 hours after bleeding. An ECG recording was obtained in 29% of patients dying within 7 days after SAH, and in 64% of those surviving longer. Tachycardia over 100 beats/min, P mitrale, and ST segment depression greater than 1.0 mm or elevation greater than 2.5 mm were statistically significantly more common among patients dying within 7 days after bleeding. ECG changes reflecting myocardial ischemia or a compromised hemodynamic state observed during the first 3 days after SAH seem to have an untoward effect on the prognosis.

Relationship of education to major risk factors and death from coronary heart disease, cardiovascular diseases and all causes, Findings of three Chicago epidemiologic studies.

SUMMARY The relationship of education to risk factors at baseline and to long-term mortality from coronary heart disease (CHD), cardiovascular diseases (CVD), and all causes was analyzed for three cohorts of middle-aged employed white men in Chicago: 8047 from the Chicago Heart Association Detection Project in Industry (CHA) (entry 1967-1973), 1250 from the Peoples Gas Company Study (PG) (entry 1958-1959) and 1730 from the Western Electric Study (WE) (entry 1957-1958). Each man was classified into one of four groups: not a high school graduate, high school graduate, some college but not a graduate, or college graduate. For all three cohorts, a graded, inverse association was observed at baseline between education and blood pressure, which was statistically significant for CHA and WE men and independent of age and relative weight. For all three cohorts, a significant, graded, inverse association was also recorded between education and cigarette use at entry. For serum cholesterol, no clear pattern was observed for the education groups in any of the three cohorts. CHA men showed a graded, inverse relationship between education and relative weight. This cohort was the only one of three showing a significant, graded inverse association between education and prevalence of ECG abnormalities at entry. For this CHA cohort, 5-year follow-up data showed a statistically significant, graded, inverse relationship between education and ageadjusted mortality rates from CHD, CVD and all causes. With adjustment for entry age, diastolic pressure, cigarettes, serum cholesterol, relative weight and ECG abnormalities, this inverse relationship remainedreduced in degree, but still statistically significant for CVD mortality. Similarly, for the pooled PG-WE cohort of 2980 with 20-21 years of follow-up, education and the three mortality end points were inversely related but not graded, with statistical significance for all three end points in the univariate analyses. The results of these studies indicate inverse relationships between education and lifestyle-related risk factors at baseline and between education and long-term risk of CHD, CVD and all-causes mortality. The inverse relationship between education and mortality is accounted for in part by the established major biomedical risk factors.

Uric acid: a risk factor for coronary heart disease?

The association between serum uric acid and the prevalence of ECG abnormalities was analyzed for 24.997 employed men and women, white and black, age 18--64 years, from the Chicago Heart Association (CHA) Detection Project in Industry. In addition, the relationships between uric acid and 5-year mortality from all causes, from cardiovascular diseases (CVD), and from coronary heart disease (CHD) were analyzed for 7804 white men and women age 45--64 years from this study and 967 white men age 44--63 years from the Chicago People's Gas Company Study. For men, the association between uric acid and the prevalence of ECG abnormalities and with mortality appear to be secondary to associations between uric acid and other risk factors. For women, however, the associations could not be explained by other risk factors.

Hyperglycaemia and coronary heart disease: The Whitehall Study

In a 5-yr follow-up of 18,403 male London civil servants, aged 40–64 yr, coronary heart disease mortality has been examined in relation to baseline levels of blood glucose concentration measured 2 hr after a 50 g oral glucose load. When deciles of the blood sugar distribution were considered, no trend of age-adjusted 5-yr CHD mortality rates was apparent. There was also no significant trend in the prevalence of Minnesota-Coded ECG abnormalities with deciles of blood sugar. However, for individuals with blood sugars above the 98th centile (106 mg/dl for ages 40–59 yr; 110 mg/dl for ages 40–64 yr) there was approximately a doubling of CHD mortality, this increase being independent of age and blood pressure. The prevalence of ECG abnormalities (Whitehall Criteria) was also increased above the 90th centile of blood sugar.

The Basle Longitudinal Study: Report on the relation of initial glucose level to baseline ECG abnormalities, peripheral artery disease, and subsequent mortality

Glucose determinations were made as part of repeat examinations among 1499 middle-aged employed men in Basle, Switzerland. Both prevalence of ECG abnormalities and frequency of peripheral artery disease were analysed to investigate possible association with initial glucose level. No consistent association was seen between baseline glucose and resting ECG endpoints, either in univariate or multivariate analyses. However, in multivariate (though not univariate) analysis, abnormalities on the post exercise ECGs were positively associated with elevated glucose. Unexpectedly, peripheral artery disease was negatively associated with glucose elevation. In mortality analyses, too few deaths from coronary disease occurred in 5 yr to permit any conclusions on long-term risk of hyperglycemia. The data available, however, did not show a positive association of mortality with glucose level.