J wave patterns and ST elevation in women☆,☆☆,★
Introduction
New data have challenged the benign nature of early repolarization (ER) by suggesting that it may be a prognostic marker of susceptibility to malignant arrhythmia and cardiovascular death1. A seminal study in 2008 by Haïssaguerre demonstrated an association between the J wave pattern and idiopathic ventricular fibrillation.2 Subsequently, a Finnish population study with 30-year follow up reported greater risk of arrhythmic deaths associated with inferior lead J wave pattern.3 However, a number of additional studies since then, riddled with nomenclature inconsistencies,4., 5. have raised further disagreements about the clinical significance of the J wave pattern. Despite the excitement surrounding this controversy, these studies have dedicated minimal attention to the clinical significance of early repolarization among women. Limited data suggest that not only do substantial differences in prevalence exist by gender,6., 7., 8., 9. but the clinical significance may be different as well.
Besides data from our institution, currently there have been nine other population studies of ST elevation, J waves, and QRS slurs that include women.7., 8., 9., 10., 11., 12., 13., 14. Of the nine studies, only six report gender-specific data8., 9., 10., 11., 12. and of those, only three report gender-specific prognostic information.11., 8., 12. In this paper, we will present our comparison of gender differences in the patterns and prevalence of J waves, terminal QRS slurs, and ST elevation in our populations of Veterans and collegiate athletes. Because of the small numbers of women of African descent, we will consider only non-African Americans in this study (another paper in the symposium will concentrate on African Americans). Only 6 deaths occurred in the clinical population so prognostic assessment would be premature but the other prognostic studies are reviewed.
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Clinical population
We performed a retrospective study of 5085 consecutive ECGs recorded from February 1997 to December 1999 at the Veterans Affairs Palo Alto Health Care System, which uses a centralized computerized ECG system for collection, storage, and analysis of ECGs (GE Healthcare, Wauwatosa. WI). We considered the first ECG for each non-African American patient and analyzed 3535 ECGs after excluding those with one or more of the following: atrial fibrillation or flutter, QRS duration > 120 ms, paced
Results
Table 1 summarizes the population characteristics for the clinical subjects and athletes. Of 3535 clinical subjects, 351 patients (9.9%) were female of average age 58 ± 17 years. Compared to the clinical population, the athlete group included a larger proportion of females (44.5% vs. 9.9%, p < 0.001) and the overall population was younger (19 ± 2 vs. 58 ± 15 years old, p < 0.001). Female athletes had lower BMIs than their clinical counterparts. Among the clinical population, there were six deaths among the
Discussion
Prior studies of early repolarization among women are limited. To date, there are nine ST elevation, J waves, and QRS slurs studies that include women, of which only six report gender specific prevalence, and only three report gender specific prognostic information. A summary of these studies is shown in Table 3 and the criteria used to define early repolarization in these studies are shown in Table 4.
As is evident in Table 4, it is problematic that each of these studies defines ER in a
Conclusion
Differing patterns of ST elevation, J waves, and QRS slurs exist between men and women with the major differences mainly due to the higher prevalence of lateral lead ST elevation in men. Surprisingly, few differences exist between the genders for the inferior leads except when lateral lead J wave pattern is present.
Acknowledgments
The opinions expressed in this article do not necessarily represent the views or policies of the Department of Veterans Affairs.
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Cited by (3)
Benign and pathological electrocardiographic changes in athletes
2015, Revista Portuguesa de CardiologiaPrognostic value of automatically detected early repolarization
2014, American Journal of CardiologyCitation Excerpt :The reported overall prevalence of ER is in line with previous studies.9 As expected, ER was associated with other demographic variables including age, gender, and race.9–11 AER prevalence was greater in younger age, men, and African-Americans.
Patterns and prognosis of all components of the J-wave pattern in multiethnic athletes and ambulatory patients
2014, American Heart JournalCitation Excerpt :Each ECG was reviewed in a generic digital format that allowed for the same processing, rereading, and recoding as for ECGs from clinical subjects. We define the J-wave pattern as elevation of the QRS-ST junction of at least 0.1 mV from baseline in the inferior or lateral leads manifested as QRS slurring or notching on the R or S wave downstroke.15-19 Electrocardiograms from the clinical and athlete populations were processed using the same software (Cardea Associates, Inc, Woodinville, WA).
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Support: None.
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Financial Disclosures: Dr. Froelicher is co-owner of Cardea Associates, Inc., developers of hardware and software for screening for CV risk.
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Disclaimer: The opinions expressed in this article do not necessarily represent the views or policies of the Department of Veterans Affairs.