Abstract
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 intermediaterisk category, 20.0% of the subjects in the CV event group and 9.1% of subjects in the noevent 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.
| Original language | English |
|---|---|
| Pages (from-to) | 805-810 |
| Number of pages | 6 |
| Journal | American Journal of Cardiology |
| Volume | 112 |
| Issue number | 6 |
| DOIs | |
| State | Published - Sep 15 2013 |
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ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Medicine(all)
Cite this
ST-T wave abnormality in lead avr and reclassification of cardiovascular risk (from the national health and nutrition examination survey-III). / Badheka, Apurva O.; Patel, Nileshkumar J.; Grover, Peeyush M.; Shah, Neeraj; Singh, Vikas; Deshmukh, Abhishek; Mehta, Kathan; Chothani, Ankit; Hoosien, Michael; Rathod, Ankit; Savani, Ghanshyambhai T.; Marzouka, George R.; Gupta, Sandeep; Mitrani, Raul; Moscucci, Mauro; Cohen, Mauricio G.
In: American Journal of Cardiology, Vol. 112, No. 6, 15.09.2013, p. 805-810.Research output: Contribution to journal › Article
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TY - JOUR
T1 - ST-T wave abnormality in lead avr and reclassification of cardiovascular risk (from the national health and nutrition examination survey-III)
AU - Badheka, Apurva O.
AU - Patel, Nileshkumar J.
AU - Grover, Peeyush M.
AU - Shah, Neeraj
AU - Singh, Vikas
AU - Deshmukh, Abhishek
AU - Mehta, Kathan
AU - Chothani, Ankit
AU - Hoosien, Michael
AU - Rathod, Ankit
AU - Savani, Ghanshyambhai T.
AU - Marzouka, George R.
AU - Gupta, Sandeep
AU - Mitrani, Raul
AU - Moscucci, Mauro
AU - Cohen, Mauricio G
PY - 2013/9/15
Y1 - 2013/9/15
N2 - 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 intermediaterisk category, 20.0% of the subjects in the CV event group and 9.1% of subjects in the noevent 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.
AB - 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 intermediaterisk category, 20.0% of the subjects in the CV event group and 9.1% of subjects in the noevent 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.
UR - http://www.scopus.com/inward/record.url?scp=84886700436&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84886700436&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2013.04.058
DO - 10.1016/j.amjcard.2013.04.058
M3 - Article
C2 - 23764245
AN - SCOPUS:84886700436
VL - 112
SP - 805
EP - 810
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
IS - 6
ER -