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. 2021 Feb 5:11:578059.
doi: 10.3389/fphys.2020.578059. eCollection 2020.

Electrocardiographic Risk Markers of Cardiac Death: Gender Differences in the General Population

Mira Anette E Haukilahti  1 , Tuomas V Kenttä  1 , Jani T Tikkanen  1 , Olli Anttonen  2 , Aapo L Aro  3 , Tuomas Kerola  2 , Antti Eranti  4 , Arttu Holkeri  3 , Harri Rissanen  5 , Markku Heliövaara  5 , Paul Knekt  5 , M Juhani Junttila  1 , Heikki V Huikuri  1
Affiliations

Electrocardiographic Risk Markers of Cardiac Death: Gender Differences in the General Population

Mira Anette E Haukilahti et al. Front Physiol. .

Abstract

Background: Cardiac death is one of the leading causes of death and sudden cardiac death (SCD) is estimated to cause approximately 50% of cardiac deaths. Men have a higher cardiac mortality than women. Consequently, the mechanisms and risk markers of cardiac mortality are not as well defined in women as they are in men.

Aim: The aim of the study was to assess the prognostic value and possible gender differences of SCD risk markers of standard 12-lead electrocardiogram in three large general population samples.

Methods: The standard 12-lead electrocardiographic (ECG) markers were analyzed from three different Finnish general population samples including total of 20,310 subjects (49.9% women, mean age 44.8 ± 8.7 years). The primary endpoint was cardiac death, and SCD and all-cause mortality were secondary endpoints. The interaction effect between women and men was assessed for each ECG variable.

Results: During the follow-up (7.7 ± 1.2 years), a total of 883 deaths occurred (24.5% women, p < 0.001). There were 296 cardiac deaths (13.9% women, p < 0.001) and 149 SCDs (14.8% women, p < 0.001). Among those who had died due to cardiac cause, women had more often a normal electrocardiogram compared to men (39.0 vs. 27.5%, p = 0.132). After adjustments with common cardiovascular risk factors and the population sample, the following ECG variables predicted the primary endpoint in men: left ventricular hypertrophy (LVH) with strain pattern (p < 0.001), QRS duration > 110 ms (p < 0.001), inferior or lateral T-wave inversion (p < 0.001) and inferolateral early repolarization (p = 0.033). In women none of the variables remained significant predictors of cardiac death in multivariable analysis, but LVH, QTc ≥ 490 ms and T-wave inversions predicted SCD (p < 0.047 and 0.033, respectively). In the interaction analysis, LVH (HR: 2.4; 95% CI: 1.2-4.9; p = 0.014) was stronger predictor of primary endpoint in women than in men.

Conclusion: Several standard ECG variables provide independent information on the risk of cardiac mortality in men but not in women. LVH and T-wave inversions predict SCD also in women.

Keywords: ECG; T wave inversion; cardiac death; gender differences; left ventricular hypertrophy; prolonged QRS; sudden cardiac death.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
A flowchart of the patient populations.
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