Utility of Normal Findings on Electrocardiogram and Echocardiogram in Subjects ≥65 Years

• Type of Material: Article
• Authors: Sanjay Venkatesh, Wake Forest University; Wesley T. O'Neal, Emory University; Stephen T. Broughton, Wake Forest University; Amit J. Shah, Emory University; Elsayed Z. Soliman, Wake Forest University
• Language: English
• Date: 2017-03-15
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amjcard.2016.11.039
• Title of Journal or Parent Work: American Journal of Cardiology
• ISSN: 0002-9149
• Volume: 119
• Issue: 6
• Start Page: 856
• End Page: 861
• Grant/Funding Information: The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.; Dr. O’Neal is supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number F32-HL-134290.; Dr. Shah is sponsored by the American Heart Association (SDG-20593449) and National Institutes of Health (UL1-TR-000454, KL2-TR-00045, K23-HL-127251).
• Keywords: Electrocardiography; Humans; Female; Reference Values; Echocardiography; Risk Assessment; Aged; Cardiovascular Diseases; Prospective Studies; Male; Aged, 80 and over
• Research Categories: Health Sciences, General; Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

The lack of abnormalities found on noninvasive cardiac testing possibly improves cardiovascular disease (CVD) risk stratification efforts and conveys reduced risk despite the presence of traditional risk factors. This analysis included 3,805 (95% white and 61% women) participants from the Cardiovascular Health Study (CHS) without baseline CVD. The combination of a normal electrocardiogram (ECG) and echocardiogram was assessed for the development of CVD. A normal ECG was defined as the absence of major or minor Minnesota code abnormalities. A normal echocardiogram was defined as the absence of contractile dysfunction, wall motion abnormalities, or abnormal left ventricular mass. Cox regression was used to compute the 10-year risk of developing coronary heart disease, stroke, and heart failure events. There were 1,555 participants (41%) with normal findings on both measures. After accounting for traditional CVD risk factors, a protective benefit was observed for all outcomes among participants who had normal ECG and echocardiographic findings (coronary heart disease: hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.46, 0.69; stroke: HR 0.57, 95% CI 0.43, 0.76; heart failure: HR 0.36, 95% CI 0.29, 0.41). The addition of this normal profile resulted in significant net reclassification improvement of the Framingham risk score for heart failure (net reclassification improvement 4.3%, 95% CI 1.0, 8.0). In conclusion, normal findings on routine noninvasive cardiac assessment identify subjects in whom CVD risk is low.