Electrocardiographic QRS-T angle and the risk of incident silent myocardial infarction in the Atherosclerosis Risk in Communities study

Zhu ming Zhang, Pentti M. Rautaharju, Ronald J. Prineas, Larisa Tereshchenko, Elsayed Z. Soliman

    Research output: Contribution to journalArticle

    6 Citations (Scopus)

    Abstract

    Background: Silent myocardial infarction (SMI) accounts for about half of the total number of MIs, and is associated with poor prognosis as is clinically documented MI (CMI). The electrocardiographic (ECG) spatial QRS/T angle has been a strong predictor of cardiovascular outcomes. Whether spatial QRS/T angle also is predictive of SMI, and the easy-to-obtain frontal QRS/T angle will show similar association are currently unknown. Methods: We examined the association between the spatial and frontal QRS/T angles, separately, with incident SMI among 9498 participants (mean age 54. years, 57% women, and 20% African-American), who were free of cardiovascular disease at baseline (visit 1, 1987-1989) from the Atherosclerosis Risk in Communities (ARIC) study. Incident SMI was defined as MI occurring after the baseline until visit 4 (1996-1998) without CMI. The frontal plane QRS/T angle was defined as the absolute difference between QRS axis and T axis. Values greater than the sex-specific 95th percentiles of the QRS/T angles were considered wide (abnormal). Results: A total of 317 (3.3%) incident SMIs occurred during a 9-year median follow-up. In a model adjusted for demographics, cardiovascular risk factors and potential confounders, both abnormal frontal (HR 2.28, 95% CI 1.58-3.29) and spatial (HR 2.10, 95% CI 1.44-3.06) QRS/T angles were associated with an over 2-fold increased risk of incident SMI. Similar patterns of associations were observed when the results were stratified by sex. Conclusions: Both frontal and spatial QRS/T angles are predicative of SMI suggesting a potential use for these markers in identifying individuals at risk.

    Original languageEnglish (US)
    JournalJournal of Electrocardiology
    DOIs
    StateAccepted/In press - 2017

    Fingerprint

    Atherosclerosis
    Myocardial Infarction
    African Americans
    Cardiovascular Diseases
    Demography

    Keywords

    • Electrocardiography
    • QRS/T angle
    • Silent myocardial infarction

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

    Cite this

    Electrocardiographic QRS-T angle and the risk of incident silent myocardial infarction in the Atherosclerosis Risk in Communities study. / Zhang, Zhu ming; Rautaharju, Pentti M.; Prineas, Ronald J.; Tereshchenko, Larisa; Soliman, Elsayed Z.

    In: Journal of Electrocardiology, 2017.

    Research output: Contribution to journalArticle

    @article{f895861d6654408d852d84cac3f8a9ee,
    title = "Electrocardiographic QRS-T angle and the risk of incident silent myocardial infarction in the Atherosclerosis Risk in Communities study",
    abstract = "Background: Silent myocardial infarction (SMI) accounts for about half of the total number of MIs, and is associated with poor prognosis as is clinically documented MI (CMI). The electrocardiographic (ECG) spatial QRS/T angle has been a strong predictor of cardiovascular outcomes. Whether spatial QRS/T angle also is predictive of SMI, and the easy-to-obtain frontal QRS/T angle will show similar association are currently unknown. Methods: We examined the association between the spatial and frontal QRS/T angles, separately, with incident SMI among 9498 participants (mean age 54. years, 57{\%} women, and 20{\%} African-American), who were free of cardiovascular disease at baseline (visit 1, 1987-1989) from the Atherosclerosis Risk in Communities (ARIC) study. Incident SMI was defined as MI occurring after the baseline until visit 4 (1996-1998) without CMI. The frontal plane QRS/T angle was defined as the absolute difference between QRS axis and T axis. Values greater than the sex-specific 95th percentiles of the QRS/T angles were considered wide (abnormal). Results: A total of 317 (3.3{\%}) incident SMIs occurred during a 9-year median follow-up. In a model adjusted for demographics, cardiovascular risk factors and potential confounders, both abnormal frontal (HR 2.28, 95{\%} CI 1.58-3.29) and spatial (HR 2.10, 95{\%} CI 1.44-3.06) QRS/T angles were associated with an over 2-fold increased risk of incident SMI. Similar patterns of associations were observed when the results were stratified by sex. Conclusions: Both frontal and spatial QRS/T angles are predicative of SMI suggesting a potential use for these markers in identifying individuals at risk.",
    keywords = "Electrocardiography, QRS/T angle, Silent myocardial infarction",
    author = "Zhang, {Zhu ming} and Rautaharju, {Pentti M.} and Prineas, {Ronald J.} and Larisa Tereshchenko and Soliman, {Elsayed Z.}",
    year = "2017",
    doi = "10.1016/j.jelectrocard.2017.05.001",
    language = "English (US)",
    journal = "Journal of Electrocardiology",
    issn = "0022-0736",
    publisher = "Churchill Livingstone",

    }

    TY - JOUR

    T1 - Electrocardiographic QRS-T angle and the risk of incident silent myocardial infarction in the Atherosclerosis Risk in Communities study

    AU - Zhang, Zhu ming

    AU - Rautaharju, Pentti M.

    AU - Prineas, Ronald J.

    AU - Tereshchenko, Larisa

    AU - Soliman, Elsayed Z.

    PY - 2017

    Y1 - 2017

    N2 - Background: Silent myocardial infarction (SMI) accounts for about half of the total number of MIs, and is associated with poor prognosis as is clinically documented MI (CMI). The electrocardiographic (ECG) spatial QRS/T angle has been a strong predictor of cardiovascular outcomes. Whether spatial QRS/T angle also is predictive of SMI, and the easy-to-obtain frontal QRS/T angle will show similar association are currently unknown. Methods: We examined the association between the spatial and frontal QRS/T angles, separately, with incident SMI among 9498 participants (mean age 54. years, 57% women, and 20% African-American), who were free of cardiovascular disease at baseline (visit 1, 1987-1989) from the Atherosclerosis Risk in Communities (ARIC) study. Incident SMI was defined as MI occurring after the baseline until visit 4 (1996-1998) without CMI. The frontal plane QRS/T angle was defined as the absolute difference between QRS axis and T axis. Values greater than the sex-specific 95th percentiles of the QRS/T angles were considered wide (abnormal). Results: A total of 317 (3.3%) incident SMIs occurred during a 9-year median follow-up. In a model adjusted for demographics, cardiovascular risk factors and potential confounders, both abnormal frontal (HR 2.28, 95% CI 1.58-3.29) and spatial (HR 2.10, 95% CI 1.44-3.06) QRS/T angles were associated with an over 2-fold increased risk of incident SMI. Similar patterns of associations were observed when the results were stratified by sex. Conclusions: Both frontal and spatial QRS/T angles are predicative of SMI suggesting a potential use for these markers in identifying individuals at risk.

    AB - Background: Silent myocardial infarction (SMI) accounts for about half of the total number of MIs, and is associated with poor prognosis as is clinically documented MI (CMI). The electrocardiographic (ECG) spatial QRS/T angle has been a strong predictor of cardiovascular outcomes. Whether spatial QRS/T angle also is predictive of SMI, and the easy-to-obtain frontal QRS/T angle will show similar association are currently unknown. Methods: We examined the association between the spatial and frontal QRS/T angles, separately, with incident SMI among 9498 participants (mean age 54. years, 57% women, and 20% African-American), who were free of cardiovascular disease at baseline (visit 1, 1987-1989) from the Atherosclerosis Risk in Communities (ARIC) study. Incident SMI was defined as MI occurring after the baseline until visit 4 (1996-1998) without CMI. The frontal plane QRS/T angle was defined as the absolute difference between QRS axis and T axis. Values greater than the sex-specific 95th percentiles of the QRS/T angles were considered wide (abnormal). Results: A total of 317 (3.3%) incident SMIs occurred during a 9-year median follow-up. In a model adjusted for demographics, cardiovascular risk factors and potential confounders, both abnormal frontal (HR 2.28, 95% CI 1.58-3.29) and spatial (HR 2.10, 95% CI 1.44-3.06) QRS/T angles were associated with an over 2-fold increased risk of incident SMI. Similar patterns of associations were observed when the results were stratified by sex. Conclusions: Both frontal and spatial QRS/T angles are predicative of SMI suggesting a potential use for these markers in identifying individuals at risk.

    KW - Electrocardiography

    KW - QRS/T angle

    KW - Silent myocardial infarction

    UR - http://www.scopus.com/inward/record.url?scp=85019236613&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=85019236613&partnerID=8YFLogxK

    U2 - 10.1016/j.jelectrocard.2017.05.001

    DO - 10.1016/j.jelectrocard.2017.05.001

    M3 - Article

    C2 - 28515002

    AN - SCOPUS:85019236613

    JO - Journal of Electrocardiology

    JF - Journal of Electrocardiology

    SN - 0022-0736

    ER -