Evidence map›Paper›PMID 24938628›Full record

ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2015

Abnormal electrocardiographic QRS transition zone and risk of mortality in individuals free of cardiovascular disease.

Natalie Bradford, Amit J Shah, Andrew Usoro, Wesley K Haisty, Elsayed Z Soliman

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Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

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0cells of the map it votes in
3citing papers in PubMed
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
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4 · The record

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5 · Who and what money

Authors and funding

5 authors.

Natalie BradfordDepartment of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
Amit J ShahDepartment of Epidemiology and Medicine, Emory University, Atlanta Veterans Affairs Medical Center, Atlanta, GA 30322, USA.
Andrew UsoroWake Forest School of Medicine, Winston-Salem, NC 27157, USA.
Wesley K HaistyDepartment of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
Elsayed Z SolimanDepartment of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA esoliman@wakehealth.edu.

Funding

Atlanta Clinical and Translational Science Institute (ACTSI) RenewalUL1TR000454 · NCATS · EMORY UNIVERSITY · PI STEPHENS, DAVID S · 2012 to 2016
$25.8M
Atlanta Clinical and Translational Science Institute (ACTSI) RenewalKL2TR000455 · NCATS · EMORY UNIVERSITY · PI STEPHENS, DAVID S · 2012 to 2016
$2.9M
NCATS NIH HHS KL2 TR000455NCATS NIH HHS KL2TR000455NCATS NIH HHS UL1 TR000454NCATS NIH HHS UL1TR000454
6 · The paper itself

Abstract

aimsWe examined the prognostic significance of abnormal electrocardiographic QRS transition zone (clockwise and counterclockwise horizontal rotations) in individuals free of cardiovascular disease (CVD). METHODS AND

resultsA total of 5541 adults (age 53 ± 10.4 years, 54% women, 24% non-Hispanic black, 25% Hispanic) without CVD or any major electrocardiogram (ECG) abnormalities from the US Third National Health and Nutrition Examination Survey were included in this analysis. Clockwise and counterclockwise horizontal rotations were defined from standard 12-lead ECG using Minnesota ECG Classification. Mortality and cause of death were assessed through 2006. At baseline, 282 participants had clockwise rotation and 3500 had counterclockwise rotation. During a median follow of 14.6 years, 1229 deaths occurred of which 415 were due to CVD. In multivariable-adjusted Cox proportional hazard analysis and compared with normal rotation, clockwise rotation was significantly associated with increased risk of all-cause mortality {hazard ratio (HR) [95% confidence interval (CI)]: 1.43 (1.15-1.78); P = 0.002} and CVD mortality [HR (95% CI): 1.61 (1.09, 2.37) P = 0.016]. In contrast, counterclockwise rotation was associated with significantly lower risk of all-cause mortality [HR (95% CI): 0.86 (0.76, 0.97); P = 0.017] and non-significant association with CVD mortality [HR (95% CI): 1.07 (0.86, 1.33); P = 0.549]. These results were consistent in subgroup analysis stratified by age, sex, and race.

conclusionIn a diverse community-based population free of CVD and compared with normal rotation, clockwise rotation was associated with increased risk of all-cause and CVD mortality while counterclockwise rotation was associated with lower risk of all-cause mortality and non-significant association with CVD mortality. These findings call for attention to these often neglected ECG markers, and probably call for revising the current definition of normal rotation.

Indexed as

Arrhythmias, CardiacDiagnosis, Computer-AssistedElectrocardiographyFemaleHumansIncidenceMaleMass ScreeningMiddle AgedReproducibility of ResultsSensitivity and SpecificitySurvival RateUnited StatesClockwise rotationCounterclockwise rotationElectrocardiogramMortalityTransition zone

Identifiers

PMID24938628
PMCPMC4342670

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.