Abstract 16004: The Prognostic Value of Automatically Detected Early Repolarization - A Focus on Hispanics
Introduction: Early repolarization (ER) associated with sudden cardiac death is based on the presence of >1mm J-point elevations in inferior and/or lateral leads with horizontal/downsloping ST-segments. Automated ECG readings of early repolarization (AER) obtained in clinical practice, on the other hand, are defined by ST segment elevation (ascending/upsloping ST-segments) in addition to J-point elevation. Nonetheless, such automated readings may cause alarm.
Methods: We therefore assessed the prevalence and prognostic significance of AER in 238,456 individuals aged 18-75 years. The study was performed at a tertiary medical center serving a racially diverse urban population with a large proportion of Hispanics (43%). The first recorded ECG of each individual during 2000-2012 was included. Patients with ventricular paced rhythm or acute coronary syndrome at the time of acquisition were excluded from the analysis. All automated ECG interpretations were reviewed for accuracy by a board certified cardiologist. The primary endpoint was death during a median follow up of 8.0±2.6 years.
Results: AER was present in 3,450 (1.6%) subjects. The prevalence varied significantly with race: African Americans 2.2%, Caucasians 0.9%, and Hispanics 1.5% (p<0.01), and sex: male 2.4% vs. female 0.6% (p<0.001). In a Cox-proportional Hazards model (Figure 1) controlling for age, smoking status, heart rate, QTc, systolic blood pressure, LDL-cholesterol, BMI, and CAD, there was no significant difference in mortality regardless of race or sex (RR 0.98 (95% CI: 0.89-1.07). This was true even if J-waves were present.
Conclusion: The prevalence of AER in Hispanics was intermediate to that of African Americans and Caucasians. This ECG finding was not associated with an increased risk of death, regardless of race or sex, and should not trigger additional diagnostic testing.
Author Disclosures: P. Aagaard: None.
- © 2014 by American Heart Association, Inc.