Value of the Electrocardiographic (P Wave, T Wave, QRS) Axis as a Predictor of Mortality in 14 Years in a Population With a High Prevalence of Chagas Disease from the Bambuí Cohort Study of Aging

doi:10.1016/j.amjcard.2017.10.020

The American Journal of Cardiology

Volume 121, Issue 3, 1 February 2018, Pages 364-369

https://doi.org/10.1016/j.amjcard.2017.10.020 Get rights and content

We sought to investigate the prognostic value of the electrocardiogram (ECG) electrical axes (P wave, T wave and QRS) as predictors of mortality in the 14-year follow-up of the prospective cohort of all residents ≥60 years living in the southeastern Brazilian city of Bambuí, a population with high prevalence of Chagas disease (ChD). Baseline ECG axes were automatically measured with normal values defined as follows: P-wave axis 0° to 75°, QRS axis −30° to 90°, and T axis 15° to 75°. Participants underwent annual follow-up visits and death was verified using death certificates. Cox proportional hazards regression was used to assess the prognostic value of ECG axes for all-cause mortality, after adjustment for potential confounders. From 1,742 qualifying residents, 1,462 were enrolled, of whom 557 (38.1%) had ChD. Mortality rate was 51.9%. In multivariable adjusted models, abnormal P-wave axis was associated with a 48% (hazard ratio [HR] = 1.48 [95% confidence interval (CI) 1.16–1.88]) increased mortality risk in patients with ChD and 43% (HR = 1.43 [CI 1.13–1.81]) in patients without ChD. Abnormal QRS axis was associated with a 34% (HR = 1.34 [CI 1.04–1.73]) increased mortality risk in patients with ChD, but not in individuals without ChD. Similarly, in the ChD group, abnormal T-wave axis was associated with a 35% (HR = 1.35 [CI 1.07–1.71]) increased mortality, but not in patients without ChD. In conclusion, abnormal P-wave, QRS, and T-wave axes were associated with increased all-cause mortality in patients with ChD. Abnormal P-wave axis was associated with mortality also among those without ChD, being the strongest predictor among ECG variables.

Section snippets

Methods

The BHAS was conducted in the southeastern Brazilian city of Bambuí (15,000 inhabitants), one of the oldest known endemic areas for ChD. Procedures used in the study and definitions of clinical variables were described in detail elsewhere.⁵ Briefly, the baseline cohort population comprised all residents aged ≥60 years on January 1, 1997, identified by means of a population census. Baseline data were collected from February to May 1997, consisting of standardized interviews, blood and clinical

Results

From the 1,742 residents of Bambuí aged 60 years and older, 1,606 were enrolled. Of these, 280 were excluded for incomplete information and 17 for conflicting serological results, leaving 1,462 for this analysis, being 557 (38.1%) seropositive for Trypanosoma cruzi infection. The baseline characteristics of these patients are described in Table 1.

The median follow-up time was 154 (79 to 179) months, equating to 15,725 person-years. Loss to follow-up was minimal. In years 1 and 14, it was 1.7%

Discussion

Our study showed that, in patients older than 60 years, abnormalities of the P-wave axis were predictive of increased mortality both in the ChD group and in the non-ChD group. Conversely, although T-wave and QRS complex axes were associated with increased mortality in the ChD group, they were not predictive of increased mortality for those without ChD. Our findings highlight the prognostic relevance of variables reported in ECG printouts, one of the least expensive and most available

Disclosures

The authors have no conflicts of interest to disclose.

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CardiomyopathyValue of the Electrocardiographic (P Wave, T Wave, QRS) Axis as a Predictor of Mortality in 14 Years in a Population With a High Prevalence of Chagas Disease from the Bambuí Cohort Study of Aging

Section snippets

Methods

Results

Discussion

Disclosures

J Electrocardiol

J Am Coll Cardiol

Lancet

Am J Cardiol

Am J Cardiol

Heart Rhythm

Am J Cardiol

Int J Cardiol

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

Lancet

Int J Cardiol

Cardiomyopathy
Value of the Electrocardiographic (P Wave, T Wave, QRS) Axis as a Predictor of Mortality in 14 Years in a Population With a High Prevalence of Chagas Disease from the Bambuí Cohort Study of Aging