The prognostic value of ECG parameters in 20-year cardiovascular risk, and in SCORE2-based prediction modelling; the...

We aimed to evaluate the prognostic value of electrocardiographic (ECG) parameters in estimating long-term cardiovascular disease (CVD) risk and their incremental predictive value when added to the HellenicSCORE II+ model in an apparently healthy adult population.

This analysis included 1482 participants (mean age 46 ± 15 years; 49% male) from the population-based prospective ATTICA study who had baseline ECG recordings, comprehensive clinical and biochemical assessment, and complete 20-year follow-up data.

During the 20-year follow-up period, 633 of the 1482 participants (43%) experienced a first fatal or non-fatal CVD event. Out of these, 86 were fatal, leading to a 20-year CVD mortality rate of 9.5% in males and 2.4% in females (p < 0.001). QT interval and QRS duration showed significant associations for both 10-year and 20-year CVD risk, with a 10 ms prolongation in QT interval to be associated with a 4.0% increase in 10-year CVD risk (HR:1.040, 95%CI:1.017-1.064) and a 5.3% increase in 20-year CVD risk (HR:1.053, 95%CI:1.038-1.068), while the same prolongation in the QRS duration was linked to a 33.6% increase in 10-year CVD risk (HR:1.336, 95%CI:1.213-1.470) and 37.2% increase in 20-year CVD risk (HR:1.372, 95%CI:1.287-1.463). The inclusion of QRS duration increased the HellenicSCORE II+ model's performance, yielding superior discrimination and reclassification measures and improving overall risk stratification.

Routine ECG parameters, particularly QRS duration, enhance long-term CVD risk prediction beyond established clinical models. Given the wide availability and low cost of ECG, these findings support further validation and integration of ECG-derived markers into preventive risk assessment strategies.