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ST segment and T wave characteristics as indicators of coronary heart disease risk: the Zutphen Study
J M Dekker1, E G Schouten, P Klootwijk
1Department of Epidemiology and Public Health, Agricultural University Wageningen, The Netherlands.
Insights
Normal T wave amplitude and slight ST segment elevation in ECGs predict lower heart disease risk in men. Abnormalities indicate increased risk for myocardial infarction, sudden death, and coronary heart disease death.
Area of Science:
- Cardiology
- Electrocardiography
- Preventive Medicine
Background:
- ST-T wave characteristics can indicate autonomic cardiac control.
- Slight ST segment elevation is linked to lower coronary heart disease mortality risk.
Purpose of the Study:
- To assess the predictive value of T wave amplitude and ST segment level on lead I.
- To evaluate risk for angina pectoris, myocardial infarction, sudden death, and coronary heart disease death in men.
Main Methods:
- Survival analysis of 876 middle-aged and 836 elderly men (born 1900-1920).
- Follow-up from 1960-1985, extended to 1990 for elderly cohort.
- Estimation of relative risks based on T wave amplitude and ST segment level categories.
Main Results:
- Higher T wave amplitude (>= 0.15 mV) correlated with reduced risk of myocardial infarction, coronary heart disease death, and sudden death.
- Slight ST segment elevation showed decreased risk (RR 0.5), while ST depression increased risk (RR 2.2).
- T wave amplitude and ST segment level associations were independent.
Conclusions:
- Normal variations in electrocardiogram (ECG) repolarization characteristics predict future heart disease.
- ST-T wave abnormalities are associated with elevated coronary heart disease risk.
- ECG repolarization patterns offer valuable prognostic information for cardiovascular events.
Objectives:
This study evaluated the predictive value of T wave amplitude and ST segment level on lead I for angina pectoris, a first myocardial infarction, sudden death and coronary heart disease death in middle-aged and elderly men.
Background:
Certain ST-T wave characteristics may reflect favorable autonomic cardiac control. Slight ST segment elevation has been reported to indicate a low risk of coronary heart disease mortality.
Methods:
A total of 876 men, born between 1900 and 1920, participated in periodic medical examinations and were followed up with respect to morbidity and mortality from 1960 to 1985. In 1985, the remaining cohort was extended to 836 elderly men from the same birth cohort who were followed up until 1990. Relative risks in categories of T wave amplitude and ST segment level were estimated by survival analysis.
Results:
Both middle-aged and elderly men with T wave amplitudes > or = 0.15 mV had a lower risk of myocardial infarction, coronary heart disease death and sudden death than men with T wave amplitudes 0.05 to 0.15 mV. The adjusted relative risk of coronary heart disease death was 0.5 (95% confidence interval [CI] 0.2 to 1.0); in men with T wave amplitude < or = 0.05 mV, relative risk was 2.0 (95% CI 1.3 to 3.1). Slight ST segment elevation was also associated with decreased risk: relative risk 0.5 (95% CI 0.3 to 1.0) compared with the isoelectric ST segment level. In men with ST segment depression, relative risk was 2.2 (95% CI 1.4 to 3.4). The association of T wave amplitude and ST segment level were independent of each other.
Conclusions:
In addition to the elevated risk of coronary heart disease that is associated with ST-T wave abnormalities, we observed that normal variations in repolarization characteristics are predictive of future heart disease.