Salah S Al-Zaiti1, Kristen N Runco, Mary G Carey. 1. School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY 14214, USA. ssabdel@buffalo.edu
Abstract
BACKGROUND: Altered ventricular repolarization and cardiovascular mortality are closely correlated, and recent novel findings show that a distorted T wave loop morphology is also strongly correlated with subsequent onset of myocardial infarction among patients with stable angina. Therefore, we hypothesized that an abnormal T wave complexity ratio (CR) can indicate vulnerability to myocardial ischemia in asymptomatic, apparently healthy adults. METHODS: Healthy firefighters were enrolled in the current investigation where they completed symptom-limited, graded exercise treadmill testing (ETT) and 24-hour Holter electrocardiogram recording. The CR was automatically calculated using principal component analysis of the high-resolution Holter electrocardiogram signal then averaged over 24 hours (CR(24h)). End points were manually analyzed from the ETT; recordings revealing horizontal ST-segment depression (≥ 1 mm) in 2 or more leads for at least 1 minute during the peak of exercise were considered indicators of myocardial ischemia. RESULTS: One hundred four firefighters (age, 44 ± 8 years; 96% men) completed both ETT and Holter recording. Firefighters with positive end points (n = 34, or 33%) had higher CR(24h) compared with those with negative end points (0.14 ± 0.06 vs 0.09 ± 0.04, P < .01); there were no demographic differences between the 2 groups. After controlling for age, smoking status, hypertension, and obesity, an abnormal CR(24h) (≥ 20%) significantly predicted exercise-induced myocardial ischemia (odds ratio, 4.6; P = .01). CONCLUSIONS: Increased T wave CR(24h) can predict myocardial ischemia in asymptomatic middle-age adults; this suggests that the distorted T wave loop morphology can reflect an altered ventricular repolarization caused by prolonged subclinical myocardial ischemia possibly caused by early coronary artery disease.
BACKGROUND: Altered ventricular repolarization and cardiovascular mortality are closely correlated, and recent novel findings show that a distorted T wave loop morphology is also strongly correlated with subsequent onset of myocardial infarction among patients with stable angina. Therefore, we hypothesized that an abnormal T wave complexity ratio (CR) can indicate vulnerability to myocardial ischemia in asymptomatic, apparently healthy adults. METHODS: Healthy firefighters were enrolled in the current investigation where they completed symptom-limited, graded exercise treadmill testing (ETT) and 24-hour Holter electrocardiogram recording. The CR was automatically calculated using principal component analysis of the high-resolution Holter electrocardiogram signal then averaged over 24 hours (CR(24h)). End points were manually analyzed from the ETT; recordings revealing horizontal ST-segment depression (≥ 1 mm) in 2 or more leads for at least 1 minute during the peak of exercise were considered indicators of myocardial ischemia. RESULTS: One hundred four firefighters (age, 44 ± 8 years; 96% men) completed both ETT and Holter recording. Firefighters with positive end points (n = 34, or 33%) had higher CR(24h) compared with those with negative end points (0.14 ± 0.06 vs 0.09 ± 0.04, P < .01); there were no demographic differences between the 2 groups. After controlling for age, smoking status, hypertension, and obesity, an abnormal CR(24h) (≥ 20%) significantly predicted exercise-induced myocardial ischemia (odds ratio, 4.6; P = .01). CONCLUSIONS: Increased T wave CR(24h) can predict myocardial ischemia in asymptomatic middle-age adults; this suggests that the distorted T wave loop morphology can reflect an altered ventricular repolarization caused by prolonged subclinical myocardial ischemia possibly caused by early coronary artery disease.
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