Skip to main content
Top
Published in: BMC Cardiovascular Disorders 1/2015

Open Access 01-12-2015 | Research article

Prognostic value of non-specific ST-T changes and left ventricular hypertrophy electrocardiographic criteria in hypertensive patients: 16-year follow-up results from the MINACOR cohort

Authors: Ernest Vinyoles, Núria Soldevila, Joan Torras, Noemí Olona, Mariano de la Figuera

Published in: BMC Cardiovascular Disorders | Issue 1/2015

Login to get access

Abstract

Background

Non-specific electrocardiographic ST-T wave changes and voltage criteria for left ventricular hypertrophy (LVH) have been associated with cardiovascular morbidity and mortality. The aim of the cohort study was to evaluate the prognostic value of non-specific ST-T changes and LVH electrocardiographic criteria on cardiovascular events and mortality in hypertensive patients.

Methods

A cohort study of 352 non-diabetic hypertensive patients, without associated cardiovascular disease, randomly selected from 1,780 hypertensive patients attended in a primary care center. An electrocardiogram was performed at the baseline visit (classified according to the Minnesota Code). Cardiovascular events and death from any cause during the follow-up period were evaluated. A multivariate analysis adjusted for gender, age and cardiovascular risk factors was performed.

Results

Data of 273 patients were analyzed: 58.2% women, age 44.1 (7.9) years, 27.8% smokers, blood pressure at baseline 142.7 (15.3)/89.3 (9.6) mmHg. During the 197.5 (59.24) month follow-up, 62 patients (22.7%) had a cardiovascular event. On multivariate analysis, age, systolic blood pressure, incidence of diabetes, smoking and electrocardiographic LVH criteria (HR 2.66 [CI 95% 1.39 – 5.10]), were significantly associated with cardiovascular events, but the presence of non-specific ST-T abnormalities (HR 0.97 [CI 95% 0.49 -1.90]) was not significantly associated with cardiovascular morbidity and mortality.

Conclusions

Hypertensive patients with LVH electrocardiographic criteria have significantly higher cardiovascular mortality and morbidity, but non-specific electrocardiographic ST-T changes are not associated with cardiovascular morbidity and mortality.
Literature
1.
go back to reference Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. The Task Force for the management of arterial hypertension of the European Hypertension Society (ESH) and of the European Society of Cardiology (ESC). 2013 ESH/ESC Guidelines for the management of arterial hypertension. J Hypertens. 2013;22:193–278. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. The Task Force for the management of arterial hypertension of the European Hypertension Society (ESH) and of the European Society of Cardiology (ESC). 2013 ESH/ESC Guidelines for the management of arterial hypertension. J Hypertens. 2013;22:193–278.
2.
go back to reference Scheltens T, de Beus MF, Hoes AW, Rutten FH, Numans ME, Mosterd A, et al. The potential yield of ECG screening of hypertensive patients: the Utrecht Health Project. J Hypertens. 2010;28:1527–33.CrossRefPubMed Scheltens T, de Beus MF, Hoes AW, Rutten FH, Numans ME, Mosterd A, et al. The potential yield of ECG screening of hypertensive patients: the Utrecht Health Project. J Hypertens. 2010;28:1527–33.CrossRefPubMed
3.
go back to reference Kannel WB, Anderson K, McGee DL, Degatano LS, Stampfer MJ. Nonspecific electrocardiographic abnormality as a predictor of coronary heart disease: the Framingham Study. Am Heart J. 1987;113:370–6.CrossRefPubMed Kannel WB, Anderson K, McGee DL, Degatano LS, Stampfer MJ. Nonspecific electrocardiographic abnormality as a predictor of coronary heart disease: the Framingham Study. Am Heart J. 1987;113:370–6.CrossRefPubMed
4.
go back to reference Schillaci G, Pirro M, Pasqualini L, Vaudo G, Ronti T, Gemelli F, et al. Prognostic significance of isolated, non-specific left ventricular repolarization abnormalities in hypertension. J Hypertens. 2004;22:407–14.CrossRefPubMed Schillaci G, Pirro M, Pasqualini L, Vaudo G, Ronti T, Gemelli F, et al. Prognostic significance of isolated, non-specific left ventricular repolarization abnormalities in hypertension. J Hypertens. 2004;22:407–14.CrossRefPubMed
5.
go back to reference Daviglus ML, Liao Y, Greenland P, Dyer AR, Liu K, Xie X, et al. Association of nonspecific minor ST-T abnormalities with cardiovascular mortality: the Chicago Western Electric Study. JAMA. 1999;281:530–6.CrossRefPubMed Daviglus ML, Liao Y, Greenland P, Dyer AR, Liu K, Xie X, et al. Association of nonspecific minor ST-T abnormalities with cardiovascular mortality: the Chicago Western Electric Study. JAMA. 1999;281:530–6.CrossRefPubMed
6.
go back to reference Prineas RJ, Grandits G, Rautaharju P, Cohen JD, Zhang ZM, Crow RS, et al. Long-term prognostic significance of isolated minor electrocardiographic T-wave abnormalities in middle-aged men free of clinical cardiovascular disease (the Multiple Risk Factor Intervention Trial [MRFIT]). Am J Cardiol. 2002;90:1391–4.CrossRefPubMed Prineas RJ, Grandits G, Rautaharju P, Cohen JD, Zhang ZM, Crow RS, et al. Long-term prognostic significance of isolated minor electrocardiographic T-wave abnormalities in middle-aged men free of clinical cardiovascular disease (the Multiple Risk Factor Intervention Trial [MRFIT]). Am J Cardiol. 2002;90:1391–4.CrossRefPubMed
7.
go back to reference Gottdiener JS, Arnold AM, Aurigemma GP, Polak JF, Tracy RP, Kitzman DW, et al. Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study. J Am Coll Cardiol. 2000;35:1628–37.CrossRefPubMed Gottdiener JS, Arnold AM, Aurigemma GP, Polak JF, Tracy RP, Kitzman DW, et al. Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study. J Am Coll Cardiol. 2000;35:1628–37.CrossRefPubMed
8.
go back to reference Verdecchia P, Reboldi G, Angeli F, Avanzini F, de Simone G, Pede S, et al. Prognostic value of serial electrocardiographic voltage and repolarization changes in essential hypertension: the HEART Survey study. Am J Hypertens. 2007;20:997–1004.CrossRefPubMed Verdecchia P, Reboldi G, Angeli F, Avanzini F, de Simone G, Pede S, et al. Prognostic value of serial electrocardiographic voltage and repolarization changes in essential hypertension: the HEART Survey study. Am J Hypertens. 2007;20:997–1004.CrossRefPubMed
9.
go back to reference Greenland P, Xie X, Liu K, Colangelo L, Liao Y, Daviglus ML, et al. Impact of minor electrocardiographic ST-segment and/or T-wave abnormalities on cardiovascular mortality during long-term follow-up. Am J Cardiol. 2003;91:1068–74.CrossRefPubMed Greenland P, Xie X, Liu K, Colangelo L, Liao Y, Daviglus ML, et al. Impact of minor electrocardiographic ST-segment and/or T-wave abnormalities on cardiovascular mortality during long-term follow-up. Am J Cardiol. 2003;91:1068–74.CrossRefPubMed
10.
go back to reference Auer R, Bauer DC, Marques-Vidal P, Butler J, Min LJ, Cornuz J, et al. Association of major and minor ECG abnormalities with coronary heart disease events. JAMA. 2012;307:1497–505.CrossRefPubMedCentralPubMed Auer R, Bauer DC, Marques-Vidal P, Butler J, Min LJ, Cornuz J, et al. Association of major and minor ECG abnormalities with coronary heart disease events. JAMA. 2012;307:1497–505.CrossRefPubMedCentralPubMed
11.
go back to reference Badheka AO, Rathod A, Marzouka GR, Patel N, Bokhari SS, Moscucci M, et al. Isolated nonspecific ST-segment and T-wave abnormalities in a cross-sectional United States population and Mortality (from NHANES III). Am J Cardiol. 2012;110:521–5.CrossRefPubMed Badheka AO, Rathod A, Marzouka GR, Patel N, Bokhari SS, Moscucci M, et al. Isolated nonspecific ST-segment and T-wave abnormalities in a cross-sectional United States population and Mortality (from NHANES III). Am J Cardiol. 2012;110:521–5.CrossRefPubMed
12.
go back to reference Denes P, Garside DB, Lloyd-Jones D, Gouskova N, Soliman EZ, Ostfeld R, et al. Major and minor electrocardiographic abnormalities and their association with underlying cardiovascular disease and risk factors in Hispanics/Latinos (from the Hispanic Community Health Study/Study of Latinos). Am J Cardiol. 2013;112:1667–75.CrossRefPubMed Denes P, Garside DB, Lloyd-Jones D, Gouskova N, Soliman EZ, Ostfeld R, et al. Major and minor electrocardiographic abnormalities and their association with underlying cardiovascular disease and risk factors in Hispanics/Latinos (from the Hispanic Community Health Study/Study of Latinos). Am J Cardiol. 2013;112:1667–75.CrossRefPubMed
13.
go back to reference De Bacquer D, De Backer G, Kornitzer M, Blackburn H. Prognostic value of ECG findings for total, cardiovascular disease, and coronary heart disease death in men and women. Heart. 1998;80:570–7.CrossRefPubMedCentralPubMed De Bacquer D, De Backer G, Kornitzer M, Blackburn H. Prognostic value of ECG findings for total, cardiovascular disease, and coronary heart disease death in men and women. Heart. 1998;80:570–7.CrossRefPubMedCentralPubMed
14.
go back to reference Liao Y, Liu K, Dyer A, Schoenberger JA, Shekelle RB, Collette P, et al. Sex differential in the relationship of electrocardiographic ST-T abnormalities to risk of coronary death: 11.5 year follow-up findings of the Chicago Heart Association Detection Project in Industry. Circulation. 1987;75:347–52.CrossRefPubMed Liao Y, Liu K, Dyer A, Schoenberger JA, Shekelle RB, Collette P, et al. Sex differential in the relationship of electrocardiographic ST-T abnormalities to risk of coronary death: 11.5 year follow-up findings of the Chicago Heart Association Detection Project in Industry. Circulation. 1987;75:347–52.CrossRefPubMed
15.
go back to reference Angeli F, Angeli E, Cavallini C, Ambrosio G, Mazzotta G, Reboldi G, et al. Electrocardiographic abnormalities of left ventricular repolarization: prognostic implications in hypertensive post-menopausal women. Maturitas. 2010;67:159–65.CrossRefPubMed Angeli F, Angeli E, Cavallini C, Ambrosio G, Mazzotta G, Reboldi G, et al. Electrocardiographic abnormalities of left ventricular repolarization: prognostic implications in hypertensive post-menopausal women. Maturitas. 2010;67:159–65.CrossRefPubMed
16.
go back to reference De la Figuera M, Vinyoles E, Mata M, Davins J, Contreras C, Contijoch C, et al. Major and minor changes in the electrocardiogram of the hypertensive patient. Aten Primaria. 1992;10:655–8.PubMed De la Figuera M, Vinyoles E, Mata M, Davins J, Contreras C, Contijoch C, et al. Major and minor changes in the electrocardiogram of the hypertensive patient. Aten Primaria. 1992;10:655–8.PubMed
17.
go back to reference Vinyoles E, Davins J, Mata M, Contijoch C, Contreras C, De la Figuera M. The recommendable frequency for performing electrocardiograms in the hypertensive patient. Aten Primaria. 1993;9:608–10. Vinyoles E, Davins J, Mata M, Contijoch C, Contreras C, De la Figuera M. The recommendable frequency for performing electrocardiograms in the hypertensive patient. Aten Primaria. 1993;9:608–10.
18.
go back to reference Vinyoles E, de la Figuera M, Mata M, Davins J. Electrocardiogram in the hypertensive patient. Aten Primaria. 1992;9:265–8.PubMed Vinyoles E, de la Figuera M, Mata M, Davins J. Electrocardiogram in the hypertensive patient. Aten Primaria. 1992;9:265–8.PubMed
19.
go back to reference de la Figuera M, Vinyoles E, Queijas MJ, Castro S, Díaz B, García R, et al. [Incidence of electrocardiographic changes in hypertension. MINACOR Study.]. Hipertensión. 2001;18:213–17. de la Figuera M, Vinyoles E, Queijas MJ, Castro S, Díaz B, García R, et al. [Incidence of electrocardiographic changes in hypertension. MINACOR Study.]. Hipertensión. 2001;18:213–17.
20.
go back to reference Prineas R, Crow R, Blackburn H. The Minnesota Code Manual of Electrocardiographic. Findings. Littleton, MA: John Wright-PSG, Inc.; 1982. Prineas R, Crow R, Blackburn H. The Minnesota Code Manual of Electrocardiographic. Findings. Littleton, MA: John Wright-PSG, Inc.; 1982.
21.
go back to reference Maiques-Galán A, Villar-Álvarez F, Brotons-Cuixart C, Torcal-Laguna J, Orozco Beltrán D, Navarro-Pérez J, et al. Grupo de Prevención Cardiovascular del PAPPS. [Preventive cardiovascular recommendations]. Aten Primaria. 2007;39 suppl 3:15–26.PubMed Maiques-Galán A, Villar-Álvarez F, Brotons-Cuixart C, Torcal-Laguna J, Orozco Beltrán D, Navarro-Pérez J, et al. Grupo de Prevención Cardiovascular del PAPPS. [Preventive cardiovascular recommendations]. Aten Primaria. 2007;39 suppl 3:15–26.PubMed
22.
23.
go back to reference Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16:31–41.CrossRefPubMed Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16:31–41.CrossRefPubMed
24.
go back to reference Vinyoles E, Rodriguez-Blanco T, De La Figuera M, Colomé JM, Tafalla M, Calbet N, et al. Variability and concordance of Cornell and Sokolow–Lyon electrocardiographic criteria in hypertensive patients. Blood Press. 2012;21:352–9.CrossRefPubMed Vinyoles E, Rodriguez-Blanco T, De La Figuera M, Colomé JM, Tafalla M, Calbet N, et al. Variability and concordance of Cornell and Sokolow–Lyon electrocardiographic criteria in hypertensive patients. Blood Press. 2012;21:352–9.CrossRefPubMed
25.
go back to reference Calbet N, Colomé JM, Ania B, Argañaraz C, Audi S, Vinyoles E, et al. [Reproducibility of unspecific ST-T electrocardiographic abnormalities in hypertensive patients]. Hipertens Riesgo Vasc. 2009;26:126.CrossRef Calbet N, Colomé JM, Ania B, Argañaraz C, Audi S, Vinyoles E, et al. [Reproducibility of unspecific ST-T electrocardiographic abnormalities in hypertensive patients]. Hipertens Riesgo Vasc. 2009;26:126.CrossRef
Metadata
Title
Prognostic value of non-specific ST-T changes and left ventricular hypertrophy electrocardiographic criteria in hypertensive patients: 16-year follow-up results from the MINACOR cohort
Authors
Ernest Vinyoles
Núria Soldevila
Joan Torras
Noemí Olona
Mariano de la Figuera
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2015
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-015-0012-6

Other articles of this Issue 1/2015

BMC Cardiovascular Disorders 1/2015 Go to the issue