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Early Repolarization: Difference between revisions
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The available prognostic studies have differing results but some suggest that end QRS notching and slurring, particularly when occurring in the inferior leads or accompanied by downward sloping ST segments, have associated risk. The differences in the studies appear to be due to terminology and methodology issues as well as design shortcomings. | The available prognostic studies have differing results but some suggest that end QRS notching and slurring, particularly when occurring in the inferior leads or accompanied by downward sloping ST segments, have associated risk. The differences in the studies appear to be due to terminology and methodology issues as well as design shortcomings. | ||
A total of 8 prognostic studies are available as on February 2013 (summarized on the | A total of 8 prognostic studies are available as on February 2013 (summarized on the [https://docs.google.com/spreadsheet/pub?hl=en&hl=en&key=0AhMCIH0M0pLYdGFhMVlGQ2RpX3VVUnJlYk1DRzlnU2c&single=true&gid=2&output=html Prognostic ''ER'' studies] spreadsheet). | ||
Clearly the best follow up study and one unlikely to be duplicated is that by Tikkannen et al. This classic study was only ''limited'' by non-computerized ECG acquisition; the paper ECG recordings from over 30 years ago (requiring using the ''adjacent lead'' criteria for accuracy unlike modern ECG analyses that rely on waveforms averaged over 10 seconds). | Clearly the best follow up study and one unlikely to be duplicated is that by Tikkannen et al. This classic study was only ''limited'' by non-computerized ECG acquisition; the paper ECG recordings from over 30 years ago (requiring using the ''adjacent lead'' criteria for accuracy unlike modern ECG analyses that rely on waveforms averaged over 10 seconds). | ||
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Sinner et al. documented an increased hazard ratio of mortality associated with ER, especially in the inferior leads. However, they used a case-cohort design which only considered a subset of their community based population ''enriched by all those who died'' resulting in a ''limited challenge'' due to the older age of those who died. | Sinner et al. documented an increased hazard ratio of mortality associated with ER, especially in the inferior leads. However, they used a case-cohort design which only considered a subset of their community based population ''enriched by all those who died'' resulting in a ''limited challenge'' due to the older age of those who died. | ||
A third outcome study, by Haruta et al. concluded that ER was only predictive of ''unexplained death''. | A third outcome study, by Haruta et al. concluded that ER was only predictive of ''unexplained death''. Although ''unexplained death'' was intended to be a surrogate for cardiac arrest, the main category coded was unexplained accidental death. | ||
A fourth study by Stavrakis et al considered 852 consecutive patients with ST elevation ≥0.1 mV in inferior or lateral leads from the VA ECG system, similar to what we have used, and randomly selected 257 age-matched patients with normal ECGs as controls. | A fourth study by Stavrakis et al considered 852 consecutive patients with ST elevation ≥0.1 mV in inferior or lateral leads from the VA ECG system, similar to what we have used, and randomly selected 257 age-matched patients with normal ECGs as controls. | ||
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A sixth and seventh studies by Olson et al and Hisamatsu et al were excellent population studies but did not consider R wave downslope phenomena (Haïssaguerre Pattern) but only ST elevation and included the anterior leads. Uberoi et al from the Veterans Affairs was one of the largest multi-ethnic population studies and considered R wave downslope phenomena (Haïssaguerre Pattern) as well as ST elevation. | A sixth and seventh studies by Olson et al and Hisamatsu et al were excellent population studies but did not consider R wave downslope phenomena (Haïssaguerre Pattern) but only ST elevation and included the anterior leads. Uberoi et al from the Veterans Affairs was one of the largest multi-ethnic population studies and considered R wave downslope phenomena (Haïssaguerre Pattern) as well as ST elevation. | ||
These eight studies are summarized in this spreadsheet | These eight studies are summarized in this spreadsheet [https://docs.google.com/spreadsheet/pub?hl=en&hl=en&key=0AhMCIH0M0pLYdGFhMVlGQ2RpX3VVUnJlYk1DRzlnU2c&single=true&gid=2&output=html Prognostic ''ER'' studies]. | ||
Studies that have used the same population as a study summarized but considered confounders are not listed but worthy of mention is the study of Perez which found a risk in non-African Americans as opposed to African Americans and a Finnish sub-study which found risk isolated to those with downsloping ST depression. Also of mention, is the study of Uberoi demonstrating any risk of R wave downslope phenomena to be dependent on accompanying Q waves and/or T wave inversion. | Studies that have used the same population as a study summarized but considered confounders are not listed but worthy of mention is the study of Perez which found a risk in non-African Americans as opposed to African Americans and a Finnish sub-study which found risk isolated to those with downsloping ST depression. Also of mention, is the study of Uberoi demonstrating any risk of R wave downslope phenomena to be dependent on accompanying Q waves and/or T wave inversion. | ||
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<biblio> | <biblio> | ||
#1 pmid=19215838 | #1 pmid=19215838 | ||
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#10 pmid=10966541 | #10 pmid=10966541 | ||
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#18 pmid=22645193 | #18 pmid=22645193 | ||
#19 pmid=22819431 | #19 pmid=22819431 | ||
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# | #20 pmid=22766081 | ||
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# | #21 pmid=22645193 | ||
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# | #22 pmid=22094072 | ||
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# | #23 pmid=23358431 | ||
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# | #24[http://www.cardiology.org/projects_repolarization_11_359809538.pdf Natural History of the Haïssaguerre Pattern: Inferior Leads] | ||
# | #25 [http://www.cardiology.org/projects_repolarization_11_2203204466.pdf Natural History of the Haïssaguerre Pattern: Lateral Leads] | ||
#26 [http://www.cardiology.org/projects_repolarization_11_4254873676.pdf Semantic Issues: Semantic Confusion (Identity theft)] | |||
#27 [http://www.cardiology.org/projects_repolarization_13_1995891580.pdf Semantic Issues: Devil in the Details] | |||
#28 [http://www.cardiology.org/projects_repolarization_13_2496272416.pdf Prognostic Value of the Haïssaguerre Patterns in a Clinical Population] | |||
#29 [http://www.cardiology.org/projects_repolarization_11_792612045.pdf Haïssaguerre Pattern and early repolarization in African Americans] | |||
#30 [http://www.cardiology.org/projects_repolarization_11_1297949109.pdf Prognosis and the Haïssaguerre Patterns: Q waves and T wave Inversion] | |||
</biblio> | </biblio> | ||
}} | }} | ||