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CLINICAL RESEARCH: CORONARY ARTERY DISEASE

Electrocardiographic Predictors of Cardiovascular Outcome in Women

The National Heart, Lung, and Blood Institute-Sponsored Women’s Ischemia Syndrome Evaluation (WISE) Study

Brian Triola, MD^_*, Marian B. Olson, MS, Steven E. Reis, MD^_*, Pentti Rautaharju, MD, C. Noel Bairey Merz, MD, Sheryl F. Kelsey, PhD, Leslee J. Shaw, PhD^||, Barry L. Sharaf, MD^¶, George Sopko, MD^# and Samir Saba, MD^_*,_*

^_* Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
Department of Community Health Sciences, Wake Forest University Medical School, Winston-Salem, North Carolina
Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
^|| Atlanta Cardiovascular Research Institute, Atlanta, Georgia
^¶ Division of Cardiology, Rhode Island Hospital, Providence, Rhode Island
^# Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute, Bethesda, Maryland.

Manuscript received August 3, 2004; revised manuscript received September 24, 2004, accepted September 28, 2004.

^_* Reprint requests and correspondence: Dr. Samir Saba, Cardiovascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, B535 PUH, Pittsburgh, Pennsylvania 15213. (Email: sabas{at}upmc.edu).

OBJECTIVES: We sought to analyze the value of infrequently measured parameters of the 12-lead electrocardiogram (ECG) in predicting cardiovascular events in women with suspected myocardial ischemia who were referred for cardiac catheterization.

BACKGROUND: Routinely analyzed ECG parameters have low predictive value for cardiovascular events in women with preserved left ventricular function and suspected myocardial ischemia. The predictive value of ECG parameters for cardiovascular disease has not been fully determined.

METHODS: Women enrolled in the National Heart, Lung, and Blood Institute-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study who had complete digital 12-lead ECG and quantitative angiography data were studied. Clinical and ECG predictors of cardiovascular disease events, defined as death, congestive heart failure, and non-fatal myocardial infarction, were determined.

RESULTS: Of 143 women with ECG and angiographic data (mean age 59 ± 13 years, left ventricular ejection fraction 64.1 ± 8.6%), 13% had events during a mean follow-up period of 3.3 ± 1.6 years. Independent predictors of event occurrences included a wider QRS-T angle (i.e., the spatial electrical angle between the QRS complex and the T-wave; p = 0.0005), wider QRS complex (p = 0.004), longer QTrr (i.e., age- and gender-adjusted QT interval; p = 0.0004), a more depressed ST-segment in precordial lead V₅ (p = 0.0002), and a higher coronary artery disease severity score (p = 0.02).

CONCLUSIONS: Several 12-lead ECG parameters, such as the QRS-T angle and the QRS and QTrr duration, are predictive of future cardiovascular events in women with suspected myocardial ischemia.

Abbreviations and Acronyms   CAD = coronary artery disease   CHF = congestive heart failure   CI = confidence interval   ECG = electrocardiogram/electrocardiographic   HR = hazard ratio   MI = myocardial infarction   QRS-T = spatial electrical angle between the QRS complex and the T-wave   QTrr = age- and gender-adjusted QT interval   WISE = Women’s Ischemia Syndrome Evaluation

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