Nonspecific ventricular repolarization abnormalities (NVRA) were associated with a 21% increased risk of all-cause mortality (HR 1.21) in individuals without cardiovascular disease.
Does the presence of nonspecific ventricular repolarization abnormalities predict all-cause and cardiovascular mortality in individuals without established cardiovascular disease?
Nonspecific ventricular repolarization abnormalities on ECG are associated with a 21% increased risk of all-cause mortality in individuals without known cardiovascular disease, suggesting they may serve as a marker for poor overall prognosis.
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Abstract Introduction Nonspecific ventricular repolarization abnormalities (NVRA) are minor electrocardiographic changes in the ST segment and/or T wave often described in individuals without apparent heart disease. Although their clinical significance remains uncertain, often no further investigation is pursued,and they are usually disregarded in the absence of accompanying symptoms. Objective To assess the impact of NVRA on the prognosis of individuals without established cardiovascular disease (CVD). Methods This analysis included 8,561 participants from the Third Report of the National Health and Nutrition Examination Survey who performed an ECG. Individuals with prior CVD or major ECG changes (e.g. QRS ≥120 ms, pathological Q waves or non-sinus rhythm) were excluded from the analysis. NVRAs were defined as subtle T wave changes (1mm) and/or ST-segment depression 0.5mm. Relevant demographic, clinical and laboratorial data were compared between patients with and without NVRAs. The prognostic impact of NVRAs on all-cause and cardiovascular mortality was assessed using a Cox regression model to adjust for cofounders. Results A total of 6,766 participants were included, of which 739 (12%) had NVRAs. This group was older (mean age 62.6 ± 12.5 vs. 57.4 ± 12.9 years, p 0.001), less frequently male (38.6% vs. 45.9%, p 0.001) or of white race (65.1% vs. 74.6%, p 0.001). This group had higher rates of hypertension (67.4% vs. 41.4%, p 0.001), diabetes mellitus (21.9% vs. 14.8%, p 0.001), dyslipidemia (24.0% vs. 23.1%, p 0.001) and higher BMI (28.2 vs. 26.7 kg/m², p 0.001). After a mean follow-up of of 18.6 ± 7.3 years, the overallall-cause mortality rate in the cohort was 49.2%,and CV mortality was 13.1%. The NVRA group experienced significantly higher all-cause mortality (64.1% vs. 47.2%, p 0.001) and CV mortality (19.8% vs. 12.2%, p 0.001) compared to the non-NVRA group. In multivariate Cox regression analysis, NVRA remained significantly associated with increased all-cause mortality (HR 1.21, 95% CI 1.06–1.40, p=0.006), but not CV mortality (HR 1.20, 95% CI 0.91-1.59, p=0.180). Conventional CV risk factors were predictors of both all-cause and CV mortality. Conclusions NVRAs are associated with higher all-cause mortality in individuals without CVD, indicating that NVRA may not be a benign finding and instead serve as a useful marker for poor overall prognosis. The clinical relevance of NVRA in relation to cardiovascular events remains unclear and warrants further investigation.
Andraz et al. (Sat,) reported a other. Nonspecific ventricular repolarization abnormalities (NVRA) were associated with a 21% increased risk of all-cause mortality (HR 1.21) in individuals without cardiovascular disease.