Details

Autor(en) / Beteiligte

• Badheka, Apurva O., MD
• Patel, Nileshkumar J., MD
• Grover, Peeyush M., MD
• Shah, Neeraj, MD
• Singh, Vikas, MD
• Deshmukh, Abhishek, MD
• Mehta, Kathan, MD
• Chothani, Ankit, MD
• Hoosien, Michael, MD
• Rathod, Ankit, MD
• Savani, Ghanshyambhai T., MD
• Marzouka, George R., MD
• Gupta, Sandeep, MD
• Mitrani, Raul D., MD
• Moscucci, Mauro, MD
• Cohen, Mauricio G., MD

Titel

ST-T Wave Abnormality in Lead aVR and Reclassification of Cardiovascular Risk (from the National Health and Nutrition Examination Survey-III)

Ist Teil von

• The American journal of cardiology, 2013-09, Vol.112 (6), p.805-810

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2013

Quelle

MEDLINE

Beschreibungen/Notizen

• Electrocardiographic lead aVR is often ignored in clinical practice. The aim of this study was to investigate whether ST-T wave amplitude in lead aVR predicts cardiovascular (CV) mortality and if this variable adds value to a traditional risk prediction model. A total of 7,928 participants enrolled in the National Health and Nutrition Examination Survey (NHANES) III with electrocardiographic data available were included. Each participant had 13.5 ± 3.8 years of follow-up. The study sample was stratified according to ST-segment amplitude and T-wave amplitude in lead aVR. ST-segment elevation (>8 μV) in lead aVR was predictive of CV mortality in the multivariate analysis when not accounting for T-wave amplitude. The finding lost significance after including T-wave amplitude in the model. A positive T wave in lead aVR (>0 mV) was the strongest multivariate predictor of CV mortality (hazard ratio 3.37, p <0.01). The addition of T-wave amplitude in lead aVR to the Framingham risk score led to a net reclassification improvement of 2.7% of subjects with CV events and 2.3% of subjects with no events (p <0.01). Furthermore, in the intermediate-risk category, 20.0% of the subjects in the CV event group and 9.1% of subjects in the no-event group were appropriately reclassified. The absolute integrated discrimination improvement was 0.012 (p <0.01), and the relative integrated discrimination improvement was 11%. In conclusion, T-wave amplitude in lead aVR independently predicts CV mortality in a cross-sectional United States population. Adding T-wave abnormalities in lead aVR to the Framingham risk score improves model discrimination and calibration with better reclassification of intermediate-risk subjects.