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Long-Term Outcome Associated with Early Repolarization on Electrocardiography
Open accessAbstract
BACKGROUND: Early repolarization, which is characterized by an elevation of the QRS-ST junction (J point) in leads other than V(1) through V(3) on 12-lead electrocardiography, has been associated with vulnerability to ventricular fibrillation, but little is known about the prognostic significance of this pattern in the general population. METHODS: We assessed the prevalence and prognostic significance of early repolarization on 12-lead electrocardiography in a community-based general population of 10,864 middle-aged subjects (mean [+/-SD] age, 44+/-8 years). The primary end point was death from cardiac causes, and secondary end points were death from any cause and death from arrhythmia during a mean follow-up of 30+/-11 years. Early repolarization was stratified according to the degree of J-point elevation (> or = 0.1 mV or > 0.2 mV) in either inferior or lateral leads. RESULTS: The early-repolarization pattern of 0.1 mV or more was present in 630 subjects (5.8%): 384 (3.5%) in inferior leads and 262 (2.4%) in lateral leads, with elevations in both leads in 16 subjects (0.1%). J-point elevation of at least 0.1 mV in inferior leads was associated with an increased risk of death from cardiac causes (adjusted relative risk, 1.28; 95% confidence interval [CI], 1.04 to 1.59; P=0.03); 36 subjects (0.3%) with J-point elevation of more than 0.2 mV in inferior leads had a markedly elevated risk of death from cardiac causes (adjusted relative risk, 2.98; 95% CI, 1.85 to 4.92; P<0.001) and from arrhythmia (adjusted relative risk, 2.92; 95% CI, 1.45 to 5.89; P=0.01). Other electrocardiographic risk markers, such as a prolonged QT interval corrected for heart rate (P=0.03) and left ventricular hypertrophy (P=0.004), were weaker predictors of the primary end point. CONCLUSIONS: An early-repolarization pattern in the inferior leads of a standard electrocardiogram is associated with an increased risk of death from cardiac causes in middle-aged subjects.
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Cites
Sudden Cardiac Arrest Associated with Early Repolarization
Haïssaguerre, M., Derval, N., Sacher, F., Jesel, L., Deisenhofer, I., de Roy, L., Pasquié, J.-L., Nogami, A., Babuty, D., Yli-Mayry, S., et al. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa071968 · Cited by 1,449
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Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association
Virani, S. S., Alonso, A., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Delling, F. N., et al. (2020) · Circulation · doi:10.1161/cir.0000000000000757 · Cited by 9,175
Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association
Benjamin, E. J., Muntner, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Das, S. R., et al. (2019) · Circulation · doi:10.1161/cir.0000000000000659 · Cited by 9,036
Heart disease and stroke statistics-2018 update: a report from the american heart association
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Heart Disease and Stroke Statistics—2016 Update: A Report From the American Heart Association
Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., Das, S. R., de Ferranti, S., Després, J.-P., Fullerton, H. J., et al. (2016) · Circulation · doi:10.1161/cir.0000000000000350 · Cited by 6,596
Heart Disease and Stroke Statistics—2015 Update: A Report From the American Heart Association
Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., de Ferranti, S., Després, J.-P., Fullerton, H. J., Howard, V. J., et al. (2015) · Circulation · doi:10.1161/cir.0000000000000152 · Cited by 5,797
Priori, S. G., Wilde, A. A., Horie, M., Cho, Y., Behr, E. R., Berul, C., Blom, N., Brugada, J., Chiang, C.-E., Huikuri, H., et al. (2013) · Heart Rhythm · doi:10.1016/j.hrthm.2013.05.014 · Cited by 1,942
Self-citationRisk stratification for sudden cardiac death: Current status and challenges for the future
Wellens, H. J. J., Schwartz, P. J., Lindemans, F. W., Buxton, A. E., Goldberger, J. J., Hohnloser, S. H., Huikuri, H. V., Kaab, S., La Rovere, M. T., Malik, M., et al. (2014) · European Heart Journal · doi:10.1093/eurheartj/ehu176 · Cited by 405
Self-citationThe Early Repolarization Pattern
Macfarlane, P. W., Antzelevitch, C., Haissaguerre, M., Huikuri, H. V., Potse, M., Rosso, R., Sacher, F., Tikkanen, J. T., Wellens, H., & Yan, G.-X. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.05.033 · Cited by 365
Self-citationSinner, M. F., Reinhard, W., Müller, M., Beckmann, B.-M., Martens, E., Perz, S., Pfeufer, A., Winogradow, J., Stark, K., Meisinger, C., et al. (2010) · PLoS Medicine · doi:10.1371/journal.pmed.1000314 · Cited by 282
“. Recently, a community-based investigation of Finnish individuals demonstrated a slightly increased cardiovascular mortality associated with ERP”
BackgroundPrevalence and Characteristics of Early Repolarization in the CASPER Registry
Derval, N., Simpson, C. S., Birnie, D. H., Healey, J. S., Chauhan, V., Champagne, J., Gardner, M., Sanatani, S., Yee, R., Skanes, A. C., et al. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.04.022 · Cited by 150
Inferolateral early repolarization in athletes
Junttila, M. J., Sager, S. J., Freiser, M., McGonagle, S., Castellanos, A., & Myerburg, R. J. (2011) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-010-9528-y · Cited by 79
Prevalence of early repolarisation/J wave patterns in the normal population
Maury, P., & Rollin, A. (2013) · Journal of Electrocardiology · doi:10.1016/j.jelectrocard.2013.06.014 · Cited by 45
Impact of ethnicity on cardiac adaptation to exercise
Sheikh, N., & Sharma, S. (2014) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2014.15 · Cited by 44
Metadata
- Authors
- Tikkanen, J. T., Anttonen, O., Junttila, M. J., Aro, A. L., Kerola, T., Rissanen, H. A., Reunanen, A., & Huikuri, H. V.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2009-12-24
- Volume
- 361
- Issue
- 26
- Pages
- 2529-2537
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2104001448
- Cited by
- 845
- References
- 1
- FWCI
- 37.96
- Type
- journal article
- Language
- en
- Open access
- bronze
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