Association of Electrocardiographic Abnormalities With Coronary Artery Calcium and Carotid Artery Intima–Media Thickness in Individuals Without Clinical Coronary Heart Disease (from the Multi-Ethnic Study of Atherosclerosis [MESA])

doi:10.1016/j.amjcard.2009.05.060

The American Journal of Cardiology

Volume 104, Issue 8, 15 October 2009, Pages 1086-1091

https://doi.org/10.1016/j.amjcard.2009.05.060 Get rights and content

Isolated minor nonspecific ST-segment and T-wave abnormalities (NSSTAs), minor and major electrocardiographic (ECG) abnormalities are established, independent risk markers for incident cardiovascular events. Their association with subclinical atherosclerosis has been postulated but is not clearly defined. The aim of this study was to define the association between ECG abnormalities and measurements of subclinical atherosclerosis. We studied participants from MESA, a multiethnic sample of men and women 45 to 84 years of age and free of clinical cardiovascular disease at enrollment. Baseline examination included measurement of traditional risk factors, 12-lead electrocardiograms at rest, coronary artery calcium (CAC) measurement, and common carotid intima–media thickness (CC-IMT). Electrocardiograms were coded using Novacode criteria and were defined as having minor abnormalities (e.g., minor NSSTTAs, first-degree atrioventricular block, and QRS-axis deviations) or major abnormalities (e.g., pathologic Q waves, major STTAs, significant dysrhythmias, and conduction system delays). Multivariable logistic and linear regressions were used to determine cross-sectional associations of ECG abnormalities with CAC and CC-IMT. Of 6,710 participants, 52.7% were women, with a mean age of 62 years. After multivariable adjustment, isolated minor STTAs and minor and major ECG abnormalities were not associated with presence of CAC (>0) in men (odds ratio 1.04, 95% confidence interval 0.81 to 1.33; 1.10, 0.91 to 1.32; and 1.03, 0.81 to 1.31, respectively) or women (1.01, 0.82 to 1.24; 1.04, 0.87 to 1.23; and 0.94, 0.73 to 1.22, respectively). Lack of association remained consistent when using log CAC and CC-IMT as continuous variables. In conclusion, ECG abnormalities are not associated with markers of subclinical atherosclerosis in a large multiethnic cohort.

Section snippets

Methods

The MESA cohort was initiated to investigate the prevalence, correlates, and progression of subclinical cardiovascular disease (i.e., disease detected by noninvasive means before it has manifested in clinical signs and symptoms). Details about the study design have previously been published.¹⁸ Briefly, from July 2000 to August 2002, 6,814 men and women 45 to 84 years old, self-identified as white, black, Hispanic, or Chinese and free of clinically apparent cardiovascular disease were recruited

Results

The study sample consisted of 6,710 subjects, of whom 52.7% were women, with a mean age of 62 years; 856 (12.8%) participants had major ECG abnormalities and were excluded from the minor ECG category, leaving 5,848 participants for inclusion in the minor and isolated minor NSTTA ECG analyses. Baseline characteristics of the study cohort stratified by gender are listed in Table 1.

Table 2 displays the proportion of participants, stratified by gender, across the 3 measurements of subclinical

Discussion

In this cross-sectional analysis of a large, multiethnic sample composed of men and women 45 to 84 years old, isolated minor NSSTAs and minor and major ECG abnormalities were not associated with the presence of subclinical atherosclerosis as indicated by the presence of CAC (Agatston score >0), extent of CAC in those with CAC, or amount of CC-IMT.

The lack of association between ECG abnormalities and subclinical atherosclerosis was observed fairly consistently across all gender and ethnic

Acknowledgment

The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org.

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Cited by (17)

Sex differences in the association between minor nonspecific ST-segment and T-wave abnormalities and coronary artery calcification
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Although minor nonspecific ST-segment and T-wave abnormalities (NSSTTA) have been associated with adverse cardiovascular outcomes, their relationship with subclinical atherosclerosis remains controversial. Therefore, the associations between electrocardiographic (ECG) abnormalities, including NSSTTA, and coronary artery calcification (CAC) were investigated in this study.
This cross-sectional study included 136,461 Korean participants with no known cardiovascular disease or cancer, who underwent a health checkup including ECG and computed tomography to measure the coronary artery calcium score (CACS) by Agatston method between 2010 and 2018. ECG abnormalities were defined in accordance with the Minnesota Code using an automated ECG analysis program. A multinomial logistic regression model was used to calculate prevalence ratios (PRs) with 95% confidence intervals (CI) for each CACS category.
In men, both NSSTTA and major ECG abnormalities were associated with all levels of CACS. The multivariable-adjusted PRs (95% CI) for CACS >400 comparing NSSTTA and major ECG abnormalities to the reference (neither NSSTTA nor major ECG abnormalities) were 1.88 (1.29–2.74) and 1.50 (1.18–1.91), respectively. Women with major ECG abnormalities were more likely to have a CACS of 101–400, the PRs (95% CI) comparing major ECG abnormalities to the reference group was 1.75 (1.18–2.57). NSSTTA were not associated with any CACS level in women.
NSSTTA and major ECG abnormalities are associated with CAC in men, though NSSTTA were not associated with CAC in women, suggesting that NSSTTA should be considered sex-specific risk factors for coronary artery disease in men, but not in women.
HIV infection and electrocardiogram abnormalities: baseline assessment from the CHART cohort
2020, Clinical Microbiology and Infection
Citation Excerpt :
Growing evidence indicates that HIV infection and subsequent persistent inflammation are associated with increased prevalence and incidence of atherosclerosis. There have been conflicting results showing either positive or no associations between ST/T abnormalities and subclinical atherosclerosis measures in the general population [29,30]. Our data showed an independent association between cIMT and ST/T abnormalities in HIV-positive but not in HIV-negative individuals.
To investigate the prevalence of various electrocardiogram (ECG) abnormalities among HIV-positive and HIV-negative individuals.
This cross-sectional evaluation included 1412 HIV-positive and 2824 HIV-negative participants aged 18 to 75 years and frequency matched by age and sex, derived from the baseline survey of Comparative HIV and Aging Research in Taizhou (CHART), China, between February and December 2017.
HIV-positive individuals had higher prevalence of sinus tachycardia (5.6% (79/1412) vs. 1.3% (36/2824), p < 0.001) and ST/T wave abnormalities (14.9% (211/1412) vs. 9.4% (264/1412), p < 0.001) but lower prevalence of sinus bradycardia (4.8% (68/1412) vs. 7.5% (211/2824), p 0.001); such associations remained statistically significant after adjusting for traditional risk factors (respectively, adjusted odds ratio (aOR) 4.68, 95% confidence interval (CI) 3.06–7.17; aOR 1.89, 95% CI 1.54–2.34; aOR 0.60, 95% CI 0.44–0.80). In adjusted models, being in higher carotid intima–media thickness categories was significantly associated with ST/T abnormalities in HIV-positive individuals only (0.78–1.00 mm: aOR 1.46, 95% CI 1.01–2.12; >1.00 mm: aOR 2.18, 95% CI 1.39–3.42), whereas being in higher blood pressure categories was significantly associated with both sinus tachycardia (prehypertension: aOR 5.61, 95% CI 1.76–17.91; hypertension: aOR 12.62, 95% CI 3.60–44.27) and ST/T abnormalities (hypertension: aOR 2.04, 95% CI 1.41–2.95) in HIV-negative individuals only. Longer duration of known HIV infection was the only HIV-specific factor of ST/T abnormalities (aOR 1.61, 95% CI 1.17–2.22), with none for sinus tachycardia.
HIV infection is independently associated with sinus tachycardia and ST/T abnormalities. Further research is needed to investigate specific mechanisms by which HIV infection leads to ECG abnormalities and to evaluate whether inclusion of ECG parameters improves cardiovascular disease prediction. Integrating ECG screening into routine HIV care is recommended in China.
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Dynamic imaging enables early detection of a decrease in regional myocardial deformation (strain) while preserving ejection fraction. The Multi-Center Study of Atherosclerosis (MESA) has demonstrated the existence of infraclinical early criteria such as systolic function defects [1] detectable from tagged MRI or echocardiographic methods for measuring myocardial deformations, i.e. Doppler tissue imaging and speckle tracking. Strain indices have the advantage of being quantitative, operator-independent, unrelated to charge conditions and better correlated with complex contraction processes during systole.
The aim of this project is to design a generic formalism for parietal and regional tracking of the left ventricle (LV) and to adapt it to $3 D + t$ cardiac imaging modalities used in clinical routine (echocardiography, gated-SPECT, cine-MRI). The estimated displacement field must be reliable enough and insensitive to various artifacts to assess regional myocardial function in 3D from the accurate and precise computation of strain. The strain has recently proved to be of great interest for diagnosis and prognostic in cardiology, but its interpretation remains difficult because of the relative nature of the indices. The clinical objective of the 3DStrain project is to bring answers about the knowledge of normality.
Prevalence and prognostic significance of ECG abnormalities in HIV-infected patients: Results from the Strategies for Management of Antiretroviral Therapy study
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Citation Excerpt :
However, the components of our composite outcome share a common risk factor, which is “atherosclerosis.” Noteworthy, ECG abnormalities have been repeatedly reported to be associated with markers of atherosclerosis.27,28 Another possible limitation is that this analysis was conducted on patients who chose to enter a clinical trial of HIV treatment.
It remains debated whether to include resting electrocardiogram (ECG) in the routine care of human immunodeficiency virus (HIV)–infected patients.
This analysis included 4518 HIV-infected patients (28% women and 29% blacks) from the Strategies for Management of Antiretroviral Therapy study, a clinical trial aimed to compare 2 HIV treatment strategies. ECG abnormalities were classified using the Minnesota Code. Cox proportional hazards analysis was used to examine the association between baseline ECG abnormalities and incident cardiovascular disease (CVD).
More than half of the participants (n = 2325, or 51.5%) had either minor or major ECG abnormalities. Minor ECG abnormalities (48.6%) were more common than major ECG abnormalities (7.7%). During a median follow-up of 28.7 months, 155 participants (3.4%) developed incident CVD. After adjusting for the study-treatment arms, the presence of major, minor, and either minor or major ECG abnormalities was significantly predictive of incident CVD (hazard ratio [95% confidence interval]: 2.76 [1.74-4.39], P < .001; 1.58 [1.14-2.20], P = .006; 1.57 [1.14-2.18], P = .006, respectively). However, after adjusting for demographics, CVD risk factors, and HIV characteristics (full model), presence of major ECG abnormalities were still significantly predictive of CVD (1.83 [1.12-2.97], P = .015) but not minor or major abnormalities taken together (1.26 [0.89-1.79], P = .18; 1.25 [0.89-1.76], P = .20, respectively). Individual ECG abnormalities that significantly predicted CVD in the fully adjusted model included major isolated ST-T abnormalities, major prolongation of QT interval, minor isolated ST-T, and minor isolated Q-QS abnormalities.
Nearly 1 in 2 of the HIV-infected patients in our study had ECG abnormalities; 1 in 13 had major ECG abnormalities. Presence of ECG abnormalities, especially major ECG abnormalities, was independently predictive of incident CVD. These results suggest that the ECG could provide a convenient risk-screening tool in HIV-infected patients.
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: This research was supported by Contracts N01-HC-95159 through N01-HC-95165 and N01-HC-95169 from the National Heart, Lung and Blood Institute, Bethesda, Maryland.

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Preventive cardiologyAssociation of Electrocardiographic Abnormalities With Coronary Artery Calcium and Carotid Artery Intima–Media Thickness in Individuals Without Clinical Coronary Heart Disease (from the Multi-Ethnic Study of Atherosclerosis [MESA])

Section snippets

Methods

Results

Discussion

Acknowledgment

J Am Coll Cardiol

Am J Cardiol

Am Heart J

J Electrocardiol

J Am Coll Cardiol

Atherosclerosis

Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: final report of the pooling project

J Chronic Dis

Association of nonspecific minor ST-T abnormalities with cardiovascular mortality: the Chicago Western Electric Study

JAMA

ST segment and T wave characteristics as indicators of coronary heart disease risk: the Zutphen Study

J Am Coll Cardiol

Common electrocardiographic markers for subsequent clinical coronary events

Circulation

Electrocardiographic abnormalities and 30-year mortality among white and black men of the Charleston Heart Study

Circulation

Prevalences of ECG findings in large population based samples of men and women

Heart Br Card Soc

Baseline risk factors and their association with outcome in the West of Scotland Coronary Prevention Study

Am J Cardiol

Clinical significance of minor nonspecific ST-segment and T-wave abnormalities in asymptomatic subjects: a systematic review

Cardiol Rev

Preventive cardiology
Association of Electrocardiographic Abnormalities With Coronary Artery Calcium and Carotid Artery Intima–Media Thickness in Individuals Without Clinical Coronary Heart Disease (from the Multi-Ethnic Study of Atherosclerosis [MESA])