Poor R-wave progression was significantly associated with an increased risk of sudden cardiac death (HR 2.13; 95% CI 1.34-3.39) and all-cause mortality in the general population.
Cohort (n=6,854)
Does poor R-wave progression on ECG predict sudden cardiac death, cardiac death, and all-cause mortality in the general population?
Poor R-wave progression on a standard 12-lead ECG is a significant predictor of sudden cardiac death, cardiac death, and all-cause mortality in the general population, particularly in those with coronary artery disease.
Effect estimate: HR 2.13 (95% CI 1.34-3.39)
BackgroundPoor R-wave progression (PRWP) is a common clinical finding on the standard 12-lead electrocardiogram (ECG), but its prognostic significance is unclear.ObjectiveThe purpose of this study was to examine the prognosis associated with PRWP in terms of sudden cardiac death (SCD), cardiac death, and all-cause mortality in general population subjects with and without coronary artery disease (CAD).MethodsData and 12-lead ECGs were collected from a Finnish general population health examination survey conducted during 1978–1980 with follow-up until 2011. The study population consisted of 6854 subjects. Main end points were SCD, cardiac death, and all-cause mortality. PRWP was defined as R-wave amplitude ≤ 0.3 mV in lead V3 and R-wave amplitude in lead V2 ≤ R-wave amplitude in lead V3.ResultsPRWP occurred in 213 subjects (3.1%). During the follow-up period of 24.3 ± 10.4 years, 3723 subjects (54.3%) died. PRWP was associated with older age, higher prevalence of heart failure and CAD, and β-blocker medication. In multivariate analyses, PRWP was associated with SCD (hazard ratio HR 2.13; 95% confidence interval CI 1.34–3.39), cardiac death (HR 1.75; 95% CI 1.35–2.15), and all-cause mortality (HR 1.29; 95% CI 1.08–1.54). In the subgroup with CAD, PRWP had a stronger association with cardiac mortality (HR 1.71; 95% CI 1.19–2.46) than in the subgroup without CAD, while the association with SCD was significant only in the subgroup with CAD (HR 2.62; 95% CI 1.38–4.98).ConclusionPRWP was associated with adverse prognosis in the general population and with SCD in subjects with CAD. Poor R-wave progression (PRWP) is a common clinical finding on the standard 12-lead electrocardiogram (ECG), but its prognostic significance is unclear. The purpose of this study was to examine the prognosis associated with PRWP in terms of sudden cardiac death (SCD), cardiac death, and all-cause mortality in general population subjects with and without coronary artery disease (CAD). Data and 12-lead ECGs were collected from a Finnish general population health examination survey conducted during 1978–1980 with follow-up until 2011. The study population consisted of 6854 subjects. Main end points were SCD, cardiac death, and all-cause mortality. PRWP was defined as R-wave amplitude ≤ 0.3 mV in lead V3 and R-wave amplitude in lead V2 ≤ R-wave amplitude in lead V3. PRWP occurred in 213 subjects (3.1%). During the follow-up period of 24.3 ± 10.4 years, 3723 subjects (54.3%) died. PRWP was associated with older age, higher prevalence of heart failure and CAD, and β-blocker medication. In multivariate analyses, PRWP was associated with SCD (hazard ratio HR 2.13; 95% confidence interval CI 1.34–3.39), cardiac death (HR 1.75; 95% CI 1.35–2.15), and all-cause mortality (HR 1.29; 95% CI 1.08–1.54). In the subgroup with CAD, PRWP had a stronger association with cardiac mortality (HR 1.71; 95% CI 1.19–2.46) than in the subgroup without CAD, while the association with SCD was significant only in the subgroup with CAD (HR 2.62; 95% CI 1.38–4.98). PRWP was associated with adverse prognosis in the general population and with SCD in subjects with CAD.
Schröder et al. (Tue,) conducted a cohort in General population (n=6,854). Poor R-wave progression (PRWP) vs. Without PRWP was evaluated on Sudden cardiac death (SCD) (HR 2.13, 95% CI 1.34-3.39). Poor R-wave progression was significantly associated with an increased risk of sudden cardiac death (HR 2.13; 95% CI 1.34-3.39) and all-cause mortality in the general population.