The Association and Predictive Ability of ECG Abnormalities with Cardiovascular Diseases: A Prospective Analysis

Glob Heart. 2020 Sep 1;15(1):59. doi: 10.5334/gh.790.

Abstract

Aims: To examine whether electrocardiography (ECG) could provide additional values to the traditional risk factors for cardiovascular disease (CVD) risk prediction among different cardiovascular risk subgroups.

Methods: A total of 7,872 community residents aged ≥40 years were followed up for a median of 4.5 years. A 12-lead resting ECG was examined for participants at baseline. CVD events including myocardial infarction, stroke and cardiovascular mortality were collected. Cox proportional hazards models were used and models of traditional risk factors with and without ECG were compared.

Results: At baseline, 2,470 participants (31.3%) had ECG abnormalities. During follow-up, 464 participants developed CVD events. ECG abnormalities were associated with an increased risk of CVD after adjustment for the traditional risk factors in participants with a 10-year atherosclerotic CVD (ASCVD) risk ≥10% (hazard ratio, HR: 1.45; 95% confidence interval, CI: 1.11, 1.91). Adding ECG abnormalities to the traditional CVD risk factors improved reclassification for those who did not experience events [net reclassification index: 8.0% (95% CI: 2%, 19.5%)], discrimination (integrated discrimination improvement: 0.7% (95% CI: 0.1%, 1.9%), and calibration (goodness of fit P value from 0.600 to 0.873) in participants with a 10-year ASCVD risk ≥10%. However, no significant association and improvement were found in participants with a 10-year ASCVD risk <10%.

Conclusions: ECG screening might provide a marginal improvement in CVD risk prediction in adults at high risk. However, ECG should not be recommended in adults at low risk.

Keywords: Calibration; Cardiovascular disease risk prediction; Discrimination; Electrocardiography; Reclassification.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / physiopathology
  • China / epidemiology
  • Electrocardiography / methods*
  • Female
  • Follow-Up Studies
  • Heart Rate / physiology*
  • Humans
  • Male
  • Mass Screening*
  • Middle Aged
  • Prospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Survival Rate / trends
  • Time Factors

Grants and funding

This work was supported by the grants from the National Key R&D Program of China (2016YFC1305600, 2017YFC1310700, 2016YFC0901200, 2016YFC1305202, 2016YFC1304904, 2018YFC1311800), the National Basic Research Program of China (973 Program, 2015CB553601), the National Natural Science Foundation of China (81700764, 81561128019, 81622011, 81870560, 81621061), the Technology Innovation Program of the Shanghai Municipal Government (18411951800), the Clinical Research Program of the Shanghai Jiaotong University School of Medicine (DLY201801), the Clinical Research Program of the Ruijin Hospital (2018CR002), and the Shanghai Sailing Program (17YF1416800). Dr. Yufang Bi was supported by the ‘Shanghai Outstanding Academic Leader Program’ and Dr. Yu Xu was supported by the ‘Outstanding Young Talent Program’ from Shanghai Municipal Government. The funding agencies had no role in the design and conduct of the study, in the collection, management, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript.