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Clinical and pathophysiologic correlates of ST-T-wave abnormalities in coronary artery disease
D M Mirvis1, F el-Zeky, R Vander Zwaag
1Veterans Administration Medical Center, Memphis, Tennessee.
Insights
Resting electrocardiogram ST-T-wave abnormalities are linked to several clinical factors including age, hypertension, diabetes, and smoking. These abnormalities also correlate with significant coronary artery disease, particularly in the left anterior descending artery.
Area of Science:
- Cardiology
- Electrocardiography
- Diagnostic Imaging
Background:
- ST-segment depression and T-wave inversion on resting electrocardiograms (ECG) can indicate underlying cardiac conditions.
- Identifying correlates of these ST-T-wave abnormalities is crucial for risk stratification and patient management.
Purpose of the Study:
- To determine the clinical, hemodynamic, and coronary angiographic correlates of ST-segment depression with or without T-wave inversion on routine resting ECGs.
- To assess the relative risk of various patient characteristics and angiographic findings associated with ST-T-wave abnormalities.
Main Methods:
- Analysis of clinical, hemodynamic, and coronary angiographic data from 9,801 patients.
- Calculation of relative risk (RR) for clinical and angiographic variables in patients with and without ST-T-wave abnormalities.
- Multivariate modeling to identify significant independent correlates.
Main Results:
- ST-T-wave abnormalities were more prevalent in older adults (>55 years), women, nonwhite individuals, hypertensive patients, those with diabetes mellitus, and cigarette smokers.
- Angiographic correlates included severe coronary obstruction (<70%), increased number of diseased vessels, and left anterior descending coronary artery obstruction.
- Multivariate analysis identified left ventricular contraction abnormality, age, gender, left anterior descending coronary artery disease, elevated end-systolic volume index, and hypertension as significant correlates.
Conclusions:
- Electrocardiographic ST-T-wave abnormalities are associated with specific clinical and pathophysiological factors.
- These findings highlight the importance of ECG abnormalities in identifying patients with significant coronary artery disease and adverse risk factors.
Abstract:
Clinical, hemodynamic and coronary angiographic data from 9,801 patients were evaluated to determine the correlates of ST-segment depression, with or without T-wave inversion, on the resting routine electrocardiogram. The relative risk (RR) of having a measured clinical or angiographic variable was computed whether or not ST-T-wave abnormalities were observed. ST-segment depression was seen significantly more often in subjects greater than 55 years of age (RR = 1.4) who were women (RR = 1.3) or nonwhite (RR = 1.5), were hypertensive (RR = 1.8), had diabetes mellitus (RR = 1.6) or who smoked cigarettes (RR = 1.5). Angiographic findings related to presence of ST-T-wave abnormalities included severe coronary obstruction (less than 70%), higher number of diseased vessels, and the presence of obstruction in the left anterior descending coronary artery. In a multivariate model, the most significant correlates of ST-T-wave abnormalities were presence of left ventricular contraction abnormality, followed by age, gender, presence of left anterior descending coronary artery disease, elevated end-systolic volume index, and a diagnosis of hypertension. Thus, electrocardiographic ST-T abnormalities has specific and significant clinical and pathophysiologic correlates.