Utility of Normal Findings on Electrocardiogram and Echocardiogram in Subjects ≥65 Years

Area of Science:

• Cardiology
• Preventive Medicine
• Diagnostic Imaging

Background:

• Cardiovascular disease (CVD) remains a leading cause of mortality worldwide.
• Accurate risk stratification is crucial for effective CVD prevention strategies.
• Traditional risk factors do not always fully capture an individual's actual CVD risk.

Purpose of the Study:

• To evaluate the prognostic value of normal findings on noninvasive cardiac testing for predicting future CVD events.
• To determine if a combination of normal electrocardiogram (ECG) and echocardiogram improves cardiovascular risk assessment.
• To assess the impact of normal cardiac test results on the risk of coronary heart disease, stroke, and heart failure.

Main Methods:

• Analysis of 3,805 participants from the Cardiovascular Health Study (CHS) without baseline CVD.
• Defined normal ECG as absence of Minnesota code abnormalities.
• Defined normal echocardiogram as absence of contractile dysfunction, wall motion abnormalities, or abnormal left ventricular mass.
• Utilized Cox regression to calculate 10-year risks for major adverse cardiovascular events.
• Assessed net reclassification improvement for the Framingham risk score.

Main Results:

• 41% of participants (1,555) had normal findings on both ECG and echocardiogram.
• Normal ECG and echocardiogram findings were associated with significantly reduced risk for coronary heart disease (HR 0.56), stroke (HR 0.57), and heart failure (HR 0.36) after adjusting for traditional risk factors.
• The combination of normal tests led to a significant net reclassification improvement for heart failure risk (4.3%).

Conclusions:

• Normal findings on routine noninvasive cardiac assessments, including ECG and echocardiogram, identify individuals at low risk for future cardiovascular disease.
• This approach enhances cardiovascular disease risk stratification beyond traditional risk factors.
• Routine noninvasive cardiac testing provides valuable prognostic information for predicting long-term CVD outcomes.