Abstract 8594: Rapid ST-upslope on Exercise Electrocardiogram Predicts Reduced Long Term Mortality from Coronary Heart Disease.
Aims The prognostic value of a rapid ST-upslope on exercise electrocardiogram (ECG) is unknown among healthy individuals, but it may be associated with a well-balanced control of the autonomic nervous system. We aim to test the hypothesis that rapid ST-upslope is associated with reduced risk of dying from coronary heart disease (CHD).
Methods and results A group of healthy middle-aged men (n=2014) participated in a cardiovascular survey examination. They underwent an examination program including a symptom limited ECG bicycle exercise test. Exercise induced ST- segments were categorized in three groups: normal ST-segment (n=1383), rapid ST- upslope (n=401) and ST-depression (n=230). Survival analyses were adjusted for smoking status, total cholesterol, systolic blood pressure, maximal heart rate, and physical fitness. The rapid ST-upslope group was associated with a 30% decreased risk of CHD-death (Hazard Ratio (HR) = 0.70 [95%CI 0.51-0.95]) compared to the normal ST-segment group (see image below). The risk of CVD-death was numerically lower in the rapid ST-upslope group (0.82 [95%CI 0.65-1.04]) compared to the normal ST-segment group. The ST-depression group was associated with a 1.45-fold (HR = 1.45 [95%CI 1.09-1.90]) increased risk of CHD-death compared to the normal ST-segment group.
Conclusions The rapid ST-upslope on exercise ECG was a common finding (20%) among healthy middle aged men and was associated with a 30% reduced risk of dying from CHD compared to individuals with normal ST-segment. We suggest that rapid ST-upslope on exercise ECG is the true healthy state.
- © 2011 by American Heart Association, Inc.