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      Electrocardiographic Risk Markers of Cardiac Death: Gender Differences in the General Population

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          Abstract

          Background

          Cardiac death is one of the leading causes of death and sudden cardiac death (SCD) is estimated to cause approximately 50% of cardiac deaths. Men have a higher cardiac mortality than women. Consequently, the mechanisms and risk markers of cardiac mortality are not as well defined in women as they are in men.

          Aim

          The aim of the study was to assess the prognostic value and possible gender differences of SCD risk markers of standard 12-lead electrocardiogram in three large general population samples.

          Methods

          The standard 12-lead electrocardiographic (ECG) markers were analyzed from three different Finnish general population samples including total of 20,310 subjects (49.9% women, mean age 44.8 ± 8.7 years). The primary endpoint was cardiac death, and SCD and all-cause mortality were secondary endpoints. The interaction effect between women and men was assessed for each ECG variable.

          Results

          During the follow-up (7.7 ± 1.2 years), a total of 883 deaths occurred (24.5% women, p < 0.001). There were 296 cardiac deaths (13.9% women, p < 0.001) and 149 SCDs (14.8% women, p < 0.001). Among those who had died due to cardiac cause, women had more often a normal electrocardiogram compared to men (39.0 vs. 27.5%, p = 0.132). After adjustments with common cardiovascular risk factors and the population sample, the following ECG variables predicted the primary endpoint in men: left ventricular hypertrophy (LVH) with strain pattern ( p < 0.001), QRS duration > 110 ms ( p < 0.001), inferior or lateral T-wave inversion ( p < 0.001) and inferolateral early repolarization ( p = 0.033). In women none of the variables remained significant predictors of cardiac death in multivariable analysis, but LVH, QTc ≥ 490 ms and T-wave inversions predicted SCD ( p < 0.047 and 0.033, respectively). In the interaction analysis, LVH (HR: 2.4; 95% CI: 1.2–4.9; p = 0.014) was stronger predictor of primary endpoint in women than in men.

          Conclusion

          Several standard ECG variables provide independent information on the risk of cardiac mortality in men but not in women. LVH and T-wave inversions predict SCD also in women.

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          Most cited references38

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          Heart Disease and Stroke Statistics—2018 Update: A Report From the American Heart Association

          Emelia Benjamin, Salim S. Virani, Clifton Callaway … (2018)
          Article 0 comments Cited 1510 times – based on 0 reviews     Review now
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            Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

            Karen Courville, Sergei Ermakov, Maheswar Satpathy … (2015)
            The Lancet, 385(9963), 117-171
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              Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update: a guideline from the american heart association.

              Véronique L Roger, Nancy A Nussmeier, Nanette K. Wenger … (2011)
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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Physiol
                Journal ID (iso-abbrev): Front Physiol
                Journal ID (publisher-id): Front. Physiol.
                Title: Frontiers in Physiology
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 1664-042X
                Publication date (Electronic): 05 February 2021
                Publication date Collection: 2020
                Volume: 11
                Electronic Location Identifier: 578059
                Affiliations
                [1] 1Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and University Hospital of Oulu , Oulu, Finland
                [2] 2Department of Internal Medicine, Päijät-Häme Central Hospital , Lahti, Finland
                [3] 3Division of Cardiology, Heart and Lung Center, University of Helsinki and Helsinki University Hospital , Helsinki, Finland
                [4] 4Heart Center, Central Hospital of North Karelia , Joensuu, Finland
                [5] 5Department of Public Health Solutions, Finnish National Institute for Health and Welfare (THL) , Helsinki, Finland
                Author notes

                Edited by: Ruben Coronel, University of Amsterdam, Netherlands

                Reviewed by: Marina Cerrone, New York University School of Medicine, United States; Hassan Khan, New York University, United States

                *Correspondence: Mira Anette E. Haukilahti, anette.haukilahti@ 123456student.oulu.fi

                This article was submitted to Cardiac Electrophysiology, a section of the journal Frontiers in Physiology

                Article
                DOI: 10.3389/fphys.2020.578059
                PMC ID: 7894046
                SO-VID: f0c7e636-a704-4d9c-9fdd-5efbff2d11be
                Copyright © Copyright © 2021 Haukilahti, Kenttä, Tikkanen, Anttonen, Aro, Kerola, Eranti, Holkeri, Rissanen, Heliövaara, Knekt, Junttila and Huikuri.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 30 June 2020
                Date accepted : 21 December 2020
                Page count
                Figures: 1, Tables: 6, Equations: 0, References: 39, Pages: 11, Words: 0
                Funding
                Funded by: Juho Vainion Säätiö 10.13039/501100004037
                Funded by: Maud Kuistilan Muistosäätiö 10.13039/100010129
                Funded by: Suomen Lääketieteen Säätiö 10.13039/100008723
                Funded by: Sydäntutkimussäätiö 10.13039/501100005633
                Funded by: Paulon Säätiö 10.13039/501100007417
                Funded by: Aarne Koskelon Säätiö 10.13039/100010133
                Categories
                Subject: Physiology
                Subject: Original Research

                ScienceOpen disciplines: Anatomy & Physiology
                Keywords: gender differences,ecg,sudden cardiac death,cardiac death,left ventricular hypertrophy,prolonged qrs,t wave inversion
                Data availability:
                ScienceOpen disciplines: Anatomy & Physiology
                Keywords: gender differences, ecg, sudden cardiac death, cardiac death, left ventricular hypertrophy, prolonged qrs, t wave inversion

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