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Association Between Temporal Changes in Early Repolarization Pattern With Long-Term Cardiovascular Outcome: A
Li-Juan Liu1,2, Na Tang3, Wen-Tao Bi1,2
1Department of Cardiology The First Affiliated HospitalSun Yat-Sen University Guangzhou China.
Journal of the American Heart Association
|March 9, 2022
Summary
Temporal changes in early repolarization pattern (ERP) increase risks for sudden cardiac death (SCD) and cardiovascular death. Repeated ECG monitoring of ERP can improve risk prediction for these outcomes.
Area of Science:
- Cardiology
- Electrocardiography
- Public Health
Background:
- The prognostic significance of early repolarization pattern (ERP) is debated.
- Previous research has not fully clarified the association between dynamic changes in ERP and adverse cardiovascular events.
Purpose of the Study:
- To investigate the hypothesis that temporal alterations in ERP are linked to elevated risks of sudden cardiac death (SCD) and cardiovascular mortality.
- To evaluate the predictive value of baseline, time-varying, and evolving ERP status for cardiovascular outcomes.
Main Methods:
- Analysis of 14,679 middle-aged participants from the Atherosclerosis Risk in Communities (ARIC) study.
- Electrocardiogram (ECG) data, including ERP status, were assessed at baseline and during three follow-up visits.
- Cox proportional hazards models were employed to analyze the association between ERP and outcomes, adjusting for covariates.
Main Results:
- Over a median follow-up of 22.5 years, time-varying ERP was associated with increased risks for SCD (HR 1.59), cardiovascular death (HR 1.70), and all-cause mortality (HR 1.16).
- Both baseline ERP and temporal changes (new-onset or persistent ERP) independently predicted higher risks of SCD and cardiovascular death compared to consistently normal ECGs.
- Specific factors like female sex, White ethnicity, anterior leads, and J-wave amplitude ≥0.2 mV indicated poorer outcomes in the context of time-varying ERP.
Conclusions:
- Baseline, time-varying, new-onset, and consistent ERP are independent predictors of SCD and cardiovascular death in a middle-aged, biracial population.
- Serial ECG assessments and monitoring of ERP changes can enhance its utility as a risk indicator for sudden cardiac death.
- These findings underscore the importance of dynamic ECG pattern analysis for cardiovascular risk stratification.
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