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Electrocardiographic J Wave and Cardiovascular Outcomes in the General Population (from the Atherosclerosis Risk In
Wesley T O'Neal1, Yi Grace Wang2, Hau-Tieng Wu3
1Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Insights
The J wave, a pattern on electrocardiograms, is not linked to higher risks of sudden cardiac death or heart disease mortality in middle-aged adults. This study found the J wave to be a benign finding in cardiovascular risk assessment.
Area of Science:
- Cardiology
- Electrocardiography
- Public Health
Background:
- The J wave, a feature of early repolarization on ECGs, has an unclear association with adverse cardiovascular events.
- Previous research shows inconsistencies due to varied J wave measurement techniques.
Purpose of the Study:
- To investigate the association between J wave detection using an automated method and cardiovascular outcomes.
- To analyze the J wave's predictive value for sudden cardiac death, coronary heart disease death, and cardiovascular mortality.
Main Methods:
- Utilized data from 14,592 participants in the Atherosclerosis Risk In Communities (ARIC) study.
- Employed a fully automated method for J wave detection at baseline and during follow-up.
- Ascertained cardiovascular outcomes through extensive record review over a median follow-up of 22 years.
Main Results:
- A J wave was identified in 1.9% of participants.
- The J wave was not associated with increased risk for sudden cardiac death (HR 0.74), coronary heart disease death (HR 0.72), or overall cardiovascular mortality (HR 1.16).
- A significant interaction by gender was observed for cardiovascular mortality, with men showing a stronger association (HR 1.54) than women (HR 0.74).
Conclusions:
- The J wave, when detected by an automated method, appears to be a benign electrocardiographic finding.
- It is not associated with an increased risk of sudden cardiac arrest in middle-aged US adults.
- Further research may explore the gender-specific interaction observed in cardiovascular mortality.
Abstract:
The association between the J wave, a key component of the early repolarization pattern, and adverse cardiovascular outcomes remains unclear. Inconsistencies have stemmed from the different methods used to measure the J wave. We examined the association between the J wave, detected by an automated method, and adverse cardiovascular outcomes in 14,592 (mean age = 54 ± 5.8 years; 56% women; 26% black) participants from the Atherosclerosis Risk In Communities (ARIC) study. The J wave was detected at baseline (1987 to 1989) and during follow-up study visits (1990 to 1992, 1993 to 1995, and 1996 to 1998) using a fully automated method. Sudden cardiac death, coronary heart disease death, and cardiovascular mortality were ascertained from hospital discharge records, death certificates, and autopsy data through December 31, 2010. A total of 278 participants (1.9%) had evidence of a J wave. Over a median follow-up of 22 years, 4,376 of the participants (30%) died. In a multivariable Cox regression analysis adjusted for demographics, cardiovascular risk factors, and potential confounders, the J wave was not associated with an increased risk of sudden cardiac death (hazard ratio [HR] 0.74, 95% CI 0.36 to 1.50), coronary heart disease death (HR 0.72, 95% CI 0.40 to 1.32), or cardiovascular mortality (HR 1.16, 95% CI 0.87 to 1.56). An interaction was detected for cardiovascular mortality by gender with men (HR 1.54, 95% CI 1.09 to 2.19) having a stronger association than women (HR 0.74, 95% CI 0.43 to 1.25; P-interaction = 0.030). In conclusion, our findings suggest that the J wave is a benign entity that is not associated with an increased risk for sudden cardiac arrest in middle-aged adults in the United States.