Electrocardiographic Risk Markers of Cardiac Death: Gender Differences in the General Population
Mira Anette E Haukilahti1, Tuomas V Kenttä1, Jani T Tikkanen1
1Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, Oulu, Finland.
Insights
Standard electrocardiogram (ECG) markers predict cardiac death in men, but less so in women. Left ventricular hypertrophy and T-wave inversions are key indicators for sudden cardiac death (SCD) risk in both sexes.
Area of Science:
- Cardiology
- Public Health
- Medical Diagnostics
Background:
- Sudden cardiac death (SCD) accounts for about 50% of all cardiac deaths, a leading cause of mortality.
- Men exhibit higher cardiac mortality rates than women, necessitating research into sex-specific risk markers.
- Standard 12-lead electrocardiogram (ECG) markers are widely used but their prognostic value may differ between genders.
Purpose of the Study:
- To evaluate the prognostic significance of standard 12-lead ECG markers for cardiac death.
- To investigate potential gender differences in the predictive power of these ECG markers.
- To analyze ECG risk markers in large general population samples.
Main Methods:
- Analysis of 12-lead ECG data from 20,310 individuals in three Finnish general population cohorts.
- Primary endpoint: cardiac death; secondary endpoints: SCD and all-cause mortality.
- Assessment of interaction effects between ECG variables and gender on mortality outcomes.
Main Results:
- In men, left ventricular hypertrophy (LVH) with strain, prolonged QRS duration (>110 ms), T-wave inversion, and early repolarization predicted cardiac death.
- In women, none of the analyzed ECG variables independently predicted cardiac death after multivariable adjustment.
- LVH, prolonged QTc (≥490 ms), and T-wave inversions were significant predictors of SCD in women; LVH showed a stronger association with cardiac death in women than in men.
Conclusions:
- Standard ECG variables offer prognostic information for cardiac mortality primarily in men.
- LVH and T-wave inversions emerge as significant predictors of SCD in both men and women.
- Further research is needed to elucidate sex-specific mechanisms and refine risk stratification for cardiac mortality in women.
Background:
Cardiac death is one of the leading causes of death and sudden cardiac death (SCD) is estimated to cause approximately 50% of cardiac deaths. Men have a higher cardiac mortality than women. Consequently, the mechanisms and risk markers of cardiac mortality are not as well defined in women as they are in men.
Aim:
The aim of the study was to assess the prognostic value and possible gender differences of SCD risk markers of standard 12-lead electrocardiogram in three large general population samples.
Methods:
The standard 12-lead electrocardiographic (ECG) markers were analyzed from three different Finnish general population samples including total of 20,310 subjects (49.9% women, mean age 44.8 ± 8.7 years). The primary endpoint was cardiac death, and SCD and all-cause mortality were secondary endpoints. The interaction effect between women and men was assessed for each ECG variable.
Results:
During the follow-up (7.7 ± 1.2 years), a total of 883 deaths occurred (24.5% women, p < 0.001). There were 296 cardiac deaths (13.9% women, p < 0.001) and 149 SCDs (14.8% women, p < 0.001). Among those who had died due to cardiac cause, women had more often a normal electrocardiogram compared to men (39.0 vs. 27.5%, p = 0.132). After adjustments with common cardiovascular risk factors and the population sample, the following ECG variables predicted the primary endpoint in men: left ventricular hypertrophy (LVH) with strain pattern (p < 0.001), QRS duration > 110 ms (p < 0.001), inferior or lateral T-wave inversion (p < 0.001) and inferolateral early repolarization (p = 0.033). In women none of the variables remained significant predictors of cardiac death in multivariable analysis, but LVH, QTc ≥ 490 ms and T-wave inversions predicted SCD (p < 0.047 and 0.033, respectively). In the interaction analysis, LVH (HR: 2.4; 95% CI: 1.2-4.9; p = 0.014) was stronger predictor of primary endpoint in women than in men.
Conclusion:
Several standard ECG variables provide independent information on the risk of cardiac mortality in men but not in women. LVH and T-wave inversions predict SCD also in women.
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