Vedant S. Pargaonkar, MD; Marco V. Perez, MD; Akash Jindal, BS; Maya B. Mathur, MS; Jonathan Myers, PhD; Victor F. Froelicher, MD
Disclaimer: The opinions expressed in this article do not necessarily represent the views or policies of the U.S. Department of Veterans Affairs.
Disclosures: Dr. Froelicher reports being co-owner of Cardeascreen, which manufactures electrocardiography devices for screening. Authors not listed here have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0598.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol, statistical code, and data set: Available from Dr. Froelicher (e-mail, victorf@stanford.edu).
Requests for Single Reprints: Victor Froelicher, MD, Director, Sports Cardiology Clinic, Center for Inherited Cardiovascular Disease, 870 Quarry Road, Falk Cardiovascular Research Building, MC-5406/Room CV-285, Stanford, CA 94305-5406; e-mail, victorf@stanford.edu.
Current Author Addresses: Dr. Pargaonkar: 300 Pasteur Drive, MC 5218, H2170, Stanford, CA 94305.
Dr. Perez: Cardiac Arrhythmia and Electrophysiology, Stanford Health Care, 300 Pasteur Drive, MC 5773, H2146, Stanford, CA 94305.
Mr. Jindal: 814 Pacheco Drive, Milpitas, CA 95035.
Ms. Mathur: Stanford University Quantitative Sciences Unit, Stanford University, 1070 Arastradero Road, Palo Alto, CA 94305.
Dr. Myers: Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Cardiology 111-C, Palo Alto, CA 94304.
Dr. Froelicher: Center for Inherited Cardiovascular Disease, 870 Quarry Road, Falk Cardiovascular Research Building, MC-5406/Room CV-285, Stanford, CA 94305-5406.
Author Contributions: Conception and design: V.S. Pargaonkar, J. Myers, V.F. Froelicher.
Analysis and interpretation of the data: V.S. Pargaonkar, M.V. Perez, A. Jindal, M.B. Mathur, J. Myers, V.F. Froelicher.
Drafting of the article: V.S. Pargaonkar, M.B. Mathur, J. Myers, V.F. Froelicher.
Critical revision of the article for important intellectual content: V.S. Pargaonkar, M.V. Perez, M.B. Mathur, J. Myers, V.F. Froelicher.
Final approval of the article: V.S. Pargaonkar, M.V. Perez, A. Jindal, M.B. Mathur, J. Myers, V.F. Froelicher.
Provision of study materials or patients: V.S. Pargaonkar, V.F. Froelicher.
Statistical expertise: V.S. Pargaonkar, M.V. Perez, M.B. Mathur, J. Myers, V.F. Froelicher.
Administrative, technical, or logistic support: V.F. Froelicher.
Collection and assembly of data: V.S. Pargaonkar, A. Jindal, J. Myers, V.F. Froelicher.
The prognostic value of early repolarization with J waves and QRS slurs remains controversial. Although these findings are more prevalent in patients with idiopathic ventricular fibrillation, their ability to predict cardiovascular death has varied across studies.
To test the hypothesis that J waves and QRS slurs on electrocardiograms (ECGs) are associated with increased risk for cardiovascular death.
Retrospective cohort.
Veterans Affairs Palo Alto Health Care System.
Veterans younger than 56 years who had resting 12-lead electrocardiography, 90.5% of whom were men.
Electrocardiograms were manually measured and visually coded using criteria of 0.1 mV or greater in at least 2 contiguous leads. J waves were measured at the peak of an upward deflection or notch at the end of QRS, and QRS slurs were measured at the top of conduction delay on the QRS downstroke. Absolute risk differences at 10 years were calculated to study the associations between J waves or QRS slurs and the primary outcome of cardiovascular death.
Over a median follow-up of 17.5 years, 859 cardiovascular deaths occurred. Of 20 661 ECGs, 4219 (20%) had J waves or QRS slurs in the inferior and/or lateral territories; of these, 3318 (78.6%) had J waves or QRS slurs in inferior leads and 1701 (40.3%) in lateral leads. The upper bound of differences in risk for cardiovascular death from any of the J-wave or QRS slur patterns suggests that an increased risk can be safely ruled out (inferior, −0.77% [95% CI, −1.27% to −0.27%]; lateral, −1.07% [CI, −1.72% to −0.43%]).
The study consisted of predominantly men, and deaths could be classified as cardiovascular but not arrhythmic.
J waves and QRS slurs did not exhibit a clinically meaningful increased risk for cardiovascular death in long-term follow-up.
None.
Pargaonkar VS, Perez MV, Jindal A, et al. Long-Term Prognosis of Early Repolarization With J-Wave and QRS Slur Patterns on the Resting Electrocardiogram: A Cohort Study. Ann Intern Med. 2015;163:747–755. [Epub ahead of print 27 October 2015]. doi: https://doi.org/10.7326/M15-0598
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© 2020
Published: Ann Intern Med. 2015;163(10):747-755.
DOI: 10.7326/M15-0598
Published at www.annals.org on 27 October 2015
Cardiac Diagnosis and Imaging, Cardiology.
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