Global electrical heterogeneity as a predictor of cardiovascular mortality in men and women

Area of Science:

• Cardiology
• Medical Electrodiagnostics

Background:

• Cardiovascular disease (CVD) remains a leading cause of mortality worldwide.
• Identifying novel risk markers for CVD and all-cause mortality is crucial for effective prevention and management.
• Global electrical heterogeneity of the heart, reflecting depolarization and repolarization, is an emerging area of interest.

Purpose of the Study:

• To investigate the predictive value of depolarization and repolarization abnormalities, specifically global electrical heterogeneity, for cardiovascular disease (CVD) and all-cause mortality.
• To identify key electrocardiogram (ECG) and vector electrocardiogram (VECG) parameters associated with mortality risk in men and women.

Main Methods:

• A cohort of 1751 participants (840 men, 911 women, average age 63) with an average follow-up of 14 years.
• Six ECG/VECG markers were analyzed: QRS-duration, QTc-interval, QRST-angle, sum of absolute QRST integral (SAI QRST), T-wave roundness, and TV1-amplitude.
• Hazard ratios (HRs) were calculated for CVD events and all-cause mortality, with models adjusted for clinical risk factors.

Main Results:

• In men, QRST-angle (HR 3.44), QTc-interval (HR 2.72), and T-wave roundness (HR 2.09) were the strongest predictors of CVD mortality.
• In women, QRST-angle (HR 2.47), SAI QRST (HR 2.37), and QTc-interval (HR 2.15) were the strongest predictors of CVD death.
• QRST-angle, QTc-interval, resting heart rate, and T-roundness predicted all-cause mortality in men, but no ECG/VECG parameters predicted all-cause mortality in women.

Conclusions:

• Specific measures of global electrical heterogeneity, namely QRST-angle and QTc-interval in men, and QRST-angle and SAI QRST in women, are significant and independent risk markers for cardiovascular mortality.
• These ECG/VECG parameters offer valuable additions to existing tools for cardiovascular risk stratification.
• The findings highlight sex-specific differences in the predictive power of ECG markers for mortality.