INTRODUCTION: It is unclear how differences in the electrocardiographic (ECG) definition of myocardial infarction (MI) impact detection rates and prognostic significance of silent MI (SMI). METHODS: This analysis include...INTRODUCTION: It is unclear how differences in the electrocardiographic (ECG) definition of myocardial infarction (MI) impact detection rates and prognostic significance of silent MI (SMI). METHODS: This analysis included 9188 participants (57.4 % women, 20 % black, age 62.6 ± 6.0 years) enrolled in the Atherosclerosis Risk in Communities study who had serial ECGs obtained between visit 1 (1987-1989) and visit 4 (1996-1998). Exclusions included known cardiovascular disease (CVD) prior to visit 1, ECG findings of MI or bundle branch block (BBB) at visit 1, or an adjudicated fatal and non-fatal MI events between visits 1 and 4. Using the Minnesota Code (MC) ECG Classification and in the absence of adjudicated MI, the following SMI definitions were derived: Standard MC MI [major Q-wave abnormality, or minor Q-wave abnormality plus major ST/T abnormality], only major Q-wave abnormality, standard significant serial Q-wave changes [Q1 to Q7], expanded MC serial Q-wave changes[Q1 to Q8], standard MC significant serial Q-wave changes or Standard MC significant serial ST/T changes, and evolving MC BBB. Cox proportional hazard models were used to examine the association of different definitions of SMI (compared to no new MI or evolving BBB) with fatal or non-fatal MI events ascertained after visit 4 until December 2016. RESULTS: The prevalence of SMI ranged from 0.6 % to 7.0 % depending on the ECG criteria defining SMI. Presence of SMI was predictive of fatal/non-fatal MI regardless of the definition but with varying levels of association. Standard MC expanded serial Q-wave changes had the strongest adjusted relationship [Hazard Ratio: 2.53 (95 % Confidence Interval (CI): 1.60-4.01)] while evolving BBB had the weakest adjusted association [HR: 1.39 (95 % CI: 0.80-2.40)]. CONCLUSIONS: The prevalence and prognostic significance of SMI are impacted by the ECG criteria defining MI. A uniform approach(s) for detection of SMI in population studies which builds on the available standard definitions that fit different research scenarios is needed.
A short-QT interval is a potential electrocardiographic finding, while short-QT syndrome (SQTS) is a rare, inherited channelopathy characterized by pathological shortening of the action potential duration leading to an i...A short-QT interval is a potential electrocardiographic finding, while short-QT syndrome (SQTS) is a rare, inherited channelopathy characterized by pathological shortening of the action potential duration leading to an increased risk of life-threatening arrhythmias. In contrast to the long QT syndrome (LQTS), data on the prevalence, diagnosis, risk stratification, treatment and prognosis of short-QT syndrome are scarce. Understanding the true risk of adverse events in exercise population or sporting activities by the patient with short-QT on 12‑leads electrocardiogram is complex: here, we summarize current knowledge and raise questions regarding the challenging relationship between the difficult SQTS diagnosis and exercise practice.
BACKGROUND: Early detection of interstitial septal fibrosis remains challenging. We describe a novel ECG pattern that may represent an early marker of fibrotic conduction changes. CASE FINDINGS: We evaluated a case demon...BACKGROUND: Early detection of interstitial septal fibrosis remains challenging. We describe a novel ECG pattern that may represent an early marker of fibrotic conduction changes. CASE FINDINGS: We evaluated a case demonstrating a triphasic QRS sequence evolving from narrow QRS (88 ms) to complete LBBB-like pattern (160 ms) within three beats. Notable features included: (i) a subtle notch within the initial 20 ms of QRS in leads II, V5 and V6; (ii) disappearance of physiological septal q waves in V5-V6; (iii) multiple notches in leads II, V4-V6; and (iv) late-QRS notching in leads III, aVL, aVF. These findings differed significantly from true LBBB criteria. INTERPRETATION: This ECG pattern may represent functional conduction alternans within fibrotic myocardium rather than anatomical His-Purkinje block. The presence of preserved rapid early forces, absence of mandatory mid-QRS notching in lateral leads, and reduced lateral voltage suggests myocardial conduction slowing rather than true complete LBBB. LIMITATIONS: This is a single-case observation without confirmatory cardiac MRI or histopathology. Computer modeling referenced was not performed by our group. The proposed mechanism remains hypothetical and requires validation in prospective cohorts.
BACKGROUND: Atrial depolarization is represented by the P wave on the electrocardiogram (ECG), while atrial repolarization (Ta wave) is usually obscured by the QRS complex. In patients with third-degree atrioventricular...BACKGROUND: Atrial depolarization is represented by the P wave on the electrocardiogram (ECG), while atrial repolarization (Ta wave) is usually obscured by the QRS complex. In patients with third-degree atrioventricular block, the Ta wave can be observed and studied. Although atrial repolarization has been described in healthy subjects and in those with paroxysmal atrial fibrillation, it has not been studied in left ventricular dysfunction. METHODS: Patients with pacemaker implanted for third-degree AV block were studied. Group 1 included patients with normal ejection fraction (LVEF ≥55 %), and group 2 included patients with reduced ejection fraction (LVEF ≤40 %). Pacemakers were programmed to VVI pacing at 40 bpm, and six standard 12‑lead ECGs were recorded. P waves not followed by QRS complex for 500 ms were identified. PTa segments were extracted, averaged, and analyzed for duration, amplitude, axis and dispersion. RESULTS: Of 31 enrolled patients, 25 were included in the final analysis (13 in group 1, 12 in group 2). The mean PTa duration was 482 ± 36 ms and was not different between the groups. P wave duration, Ta amplitude, and Ta axis also were not different. Ta axis was northwest in all patients, opposite to the direction of atrial depolarisation. PTa dispersion was significantly higher in group 2 (74 ± 21 ms) compared to group 1 (54 ± 14 ms, p = 0.008). CONCLUSION: PTa wave amplitude, duration, and axis are not altered in left ventricular dysfunction. PTa dispersion is increased in these patients and may be a marker of elevated risk for atrial arrhythmias.
OBJECTIVE: To evaluate the diagnostic accuracy and clinical impact of 18‑lead electrocardiography compared with conventional 12‑lead ECG in patients with suspected acute coronary syndromes (ACS). METHODS: A systematic re...OBJECTIVE: To evaluate the diagnostic accuracy and clinical impact of 18‑lead electrocardiography compared with conventional 12‑lead ECG in patients with suspected acute coronary syndromes (ACS). METHODS: A systematic review and meta-analysis were conducted by searching PubMed, Embase, Scopus, and the Cochrane Library from inception to August 2025. Eligible studies compared 18‑lead with 12‑lead ECG using angiography, biomarkers, or imaging as reference standards. Data were extracted to construct 2 × 2 tables where available, and pooled sensitivity, specificity, and risk ratios were calculated using random-effects models. Risk of bias was assessed with QUADAS-2, and certainty of evidence was graded with GRADE. RESULTS: Seven studies met the inclusion criteria, of which four provided extractable diagnostic accuracy data (n ≈ 535). Across studies, 18‑lead ECG significantly improved sensitivity for posterior myocardial infarction (≈80-85 % vs 55-65 % with 12‑lead) and right ventricular infarction (≈78 % vs 58 %) while preserving specificity (≈90 %). Pooled analysis demonstrated a 34 % relative improvement in diagnostic yield (RR 1.34, 95 % CI 1.18-1.55; p < 0.01). Approximately 10-15 % of patients initially classified as NSTEMI were reclassified as STEMI-equivalents using 18‑lead recordings. Evidence of earlier catheterization laboratory activation was noted in emergency department cohorts. CONCLUSION: Eighteen‑lead ECG enhances detection of posterior and right ventricular infarctions without loss of specificity and supports earlier intervention. Broader clinical adoption and outcome-focused trials are warranted.
INTRODUCTION: Observational studies indicate a link between arrhythmias, electrocardiogram (ECG) characteristics, and non-alcoholic fatty liver disease (NAFLD). However, it is uncertain whether NAFLD acts merely as a ris...INTRODUCTION: Observational studies indicate a link between arrhythmias, electrocardiogram (ECG) characteristics, and non-alcoholic fatty liver disease (NAFLD). However, it is uncertain whether NAFLD acts merely as a risk marker or directly contributes to the development and progression of these arrhythmic disorders. Mendelian randomization (MR) was employed to investigate the causal relationship of NAFLD on arrhythmias and ECG traits. METHODS: A two-sample Mendelian randomization (MR) analysis was performed to examine the causal relationship of genetically predicted NAFLD (imaging and biopsy confirmed NAFLD) on arrhythmias [i.e., atrial fibrillation (AF), left bundle branch block (LBBB), right bundle branch block (RBBB), and atrioventricular block (AVB)] and ECG traits [i.e., P wave duration (PWD), PR interval, QT interval, and QRS duration]. We utilized the inverse variance weighted method as the principal analytical approach, supplemented by a range of sensitivity analyses. RESULTS: Inverse-variance weighted method showed a statistically significant association between genetically predicted NAFLD and LBBB (OR: 1.261, 95% CI: 1.066-1.491, p = 0.0068). However, there was insufficient evidence to support a significant association between genetically predicted NAFLD and other arrhythmias or electrocardiographic characteristics. Sensitivity analyses revealed low heterogeneity and the absence of horizontal pleiotropy, suggesting that the findings are robust. CONCLUSION: The study indicates a causal relationship between genetically predicted NAFLD and LBBB, suggesting that NAFLD may influence cardiac electrical activity.
The coexistence of atrial fibrillation (AF) and ventricular fibrillation (VF) in a structurally normal heart is a rare presentation. We describe a case of a previously healthy, 30-year-old man presenting with a family hi...The coexistence of atrial fibrillation (AF) and ventricular fibrillation (VF) in a structurally normal heart is a rare presentation. We describe a case of a previously healthy, 30-year-old man presenting with a family history of sudden cardiac death. The ECG during admission showed early repolarization pattern and he spontaneously developed AF, junctional rhythm and VF and dynamic QT shortening with prominent U waves during the arrhythmic storm. Genetic testing revealed novel heterozygous missense substitution p.Ile73Val in exon 2 of the CACNA1C gene.
The role of electrocardiography (ECG) in pre-participation screening (PPS) has long been debated, but accumulating evidence supports its importance in detecting cardiovascular diseases associated with sudden cardiac deat...The role of electrocardiography (ECG) in pre-participation screening (PPS) has long been debated, but accumulating evidence supports its importance in detecting cardiovascular diseases associated with sudden cardiac death (SCD). Its systematic use has contributed to a reduction in SCD incidence among athletes. Over the past two decades, interpretation standards have evolved, culminating in the International Criteria, which classify ECG findings as normal, borderline, or abnormal. Training-related and vagal tone-related changes are recognized as physiological variants, borderline alterations represent intermediate findings that require careful contextual interpretation, and abnormal patterns constitute true red flags that always warrant further investigation. Additional challenges concern special populations, including children, women, and master athletes, where training-induced remodeling and ECG expression may differ from young male cohorts on which the current criteria are based. While the International Criteria remain the reference framework, future updates are needed to refine thresholds, incorporate emerging evidence, and adapt to diverse athletic populations, with the ultimate goal of improving diagnostic accuracy and preventing SCD.
We describe an unusual case of focal atrial tachycardia (FAT) from the left inferior pulmonary vein (PV) in a 12- year old boy treated successfully by high power short duration (HPSD) ablation. The patient was referred t...We describe an unusual case of focal atrial tachycardia (FAT) from the left inferior pulmonary vein (PV) in a 12- year old boy treated successfully by high power short duration (HPSD) ablation. The patient was referred to our center for ablation of incessant FAT with recurrent transient degeneration into atrial fibrillation. The electrophysiological study revealed FAT with a micro-reentrant like activation from the left inferior PV. To reduce the risk of complications to surrounding structures, isolation of the left pulmonary veins was performed using HPSD (65 W, 6-15 s) ablation. During a follow-up period of 12 months, the patient remained in stable sinus rhythm.
We report a 26-year patient with univentricular physiology who underwent bidirectional Glenn with left pulmonary artery plasty followed by pulmonary artery stenting and finally underwent fenestrated extra-cardiac Fontan...We report a 26-year patient with univentricular physiology who underwent bidirectional Glenn with left pulmonary artery plasty followed by pulmonary artery stenting and finally underwent fenestrated extra-cardiac Fontan operation at age of 5 years. He was asymptomatic with an interesting ECG with atrial ectopic at presentation. We try to explain the basic mechanism and patterns of arrythmias in post-Fontan patients.
BACKGROUND: Numerous electrocardiographic (ECG) criteria have been reported to predict the culprit artery in cases of inferior myocardial infarction (MI). This study aimed to identify the most reliable predictive criteri...BACKGROUND: Numerous electrocardiographic (ECG) criteria have been reported to predict the culprit artery in cases of inferior myocardial infarction (MI). This study aimed to identify the most reliable predictive criteria and assess their applicability in a cohort of patients with multivessel coronary disease. METHODS: This cross-sectional study included patients with inferior MI who underwent primary percutaneous coronary intervention between January 2019 and August 2024 at Gia Dinh Hospital. We evaluated 43 previously reported ECG criteria, algorithms, and scoring systems to determine whether the culprit artery was the right coronary artery (RCA) or the left circumflex artery (LCx). Subgroup analyses were performed based on the extent of coronary artery stenosis to assess the predictive value of ECG in multivessel coronary disease. RESULTS: We evaluated 431 inferior MI patients with an average age of 62.1 ± 12.2 years, with men comprising 76.1 %. There were 63 (14.6 %) patients with one-vessel coronary disease, 136 (31.6 %) with two-vessel coronary disease, and 232 (53.8 %) with three-vessel coronary disease. The ST elevation (STE) in lead III greater than in lead II was identified as the best predictor of RCA as the culprit artery, demonstrating a sensitivity of 92 %, specificity of 67 %, positive predictive value of 94 %, negative predictive value of 59 %, accuracy of 88 %, and an area under the curve (AUC) of 0.8 (95 % CI 0.74-0.85) with p < 0.001. When analyzing the multivessel coronary disease subgroup, the STE III > II criterion maintained its strong predictive ability, with a sensitivity of 92 %, a positive predictive value of 95 %, AUC of 0.8 (95 % CI 0.74-0.87) and p < 0.001. CONCLUSIONS: The criterion of STE III > II remains a robust predictor for identifying the culprit artery in inferior MI, regardless of the presence of multivessel coronary disease.
BACKGROUND: Electrocardiographic criteria for left ventricular hypertrophy (ECG-LVH) show poor diagnostic performance. Distance factors, such as the chest wall - left ventricle (CWLV) distance and subcutaneous adipose ti...BACKGROUND: Electrocardiographic criteria for left ventricular hypertrophy (ECG-LVH) show poor diagnostic performance. Distance factors, such as the chest wall - left ventricle (CWLV) distance and subcutaneous adipose tissue (SAT) have been proposed as alternative modulators of ECG amplitudes both on a theoretical and a clinical basis. We aimed to investigate the independent associations of CWLV, SAT, and LVM with ECG amplitudes. METHODS: In this cross-sectional study using cardiac magnetic resonance (CMR) imaging in 49 healthy volunteers (22 female, mean age 37.1 years, median BMI 22.8 kg/m), we analysed the CWLV distance, SAT and LVM in relation to QRS amplitudes from a resting 12‑lead ECG. RESULTS: In a multivariable regression model, CWLV distance, measured with excellent reliability (inter-observer ICC = 0.995, p < 0.001), was the strongest predictor of Sokolow-Lyon voltage (SV1 + RV5), followed by LVM (std. β = -0.48 and 0.38 respectively, both p < 0.002, adj. R = 0.53). SAT correlated with most ECG amplitudes to a similar degree as did LVM, but in the opposite direction. In females, CWLV distance but not LVM correlated with Sokolow-Lyon voltage. CONCLUSIONS: We found that a non-cardiac variable (CWLV) was a stronger predictor of ECG amplitudes than was LVM, and that SAT was negatively correlated with ECG amplitudes, even in a sample with a normal median BMI. These findings suggest that distance factors may influence the ECG of non-obese persons and contribute to the limited accuracy of ECG-LVH criteria. Our findings also question the validity of Sokolow-Lyon voltage for assessment of LVM in females.
BACKGROUND: Advancements in computerized electrocardiogram (ECG) interpretation have improved efficiency, but concerns remain regarding diagnostic accuracy for atrial fibrillation (AF). Misclassification may result in in...BACKGROUND: Advancements in computerized electrocardiogram (ECG) interpretation have improved efficiency, but concerns remain regarding diagnostic accuracy for atrial fibrillation (AF). Misclassification may result in inappropriate treatment and adverse outcomes. OBJECTIVES: To compare the diagnostic accuracy of computerized ECG interpretation versus cardiologist over-read for AF and evaluate the clinical consequences of diagnostic errors. METHODS: We conducted a retrospective study of 5000 ECGs obtained at the Veterans Affairs Caribbean Healthcare System between September and November 2017. All ECGs were initially interpreted by automated software. A subset of 905 ECGs underwent over-read at the time of care. Separately, two board-certified cardiologists independently reviewed all 5000 ECGs in a blinded fashion and completed standardized interpretation forms. Diagnostic metrics were compared using 2-proportion z-tests and McNemar's test. Logistic regression identified predictors of misclassification. Clinical records were reviewed for treatment consequences. RESULTS: Computerized interpretation identified 803 (16 %) AF-related ECGs; of these, 70 % were true AF, 11 % false positives, and 19 % false negatives. Cardiologist interpretation showed higher accuracy: sensitivity 87 % vs. 78 %, specificity 99 % vs. 97 %, PPV 98 % vs. 86 %, NPV 99 % vs. 97 % (all p < 0.01). Ventricular pacing (OR 10.2), undetermined rhythm (OR 13.4), and tachycardia (OR 1.8) independently predicted misclassification (p < 0.001). Among misclassified ECGs, 41 % of errors were unrecognized, leading to delayed anticoagulation (18 %), inappropriate initiation (12 %), and three adverse events. CONCLUSIONS: Computerized ECG interpretation of AF is prone to diagnostic error. Cardiologist over-read improves accuracy and may reduce preventable harm. CONDENSED ABSTRACT: Computerized ECG interpretation misclassified AF in 30 % of cases, 11 % overcalls and 19 % missed diagnoses. Cardiologist over-reading demonstrated superior accuracy (87 % sensitivity, 99 % specificity), minimizing both false positives and negatives. In 41 % of erroneous computer interpretations, providers failed to recognize the error, leading to delayed anticoagulation, inappropriate therapy, two thromboembolic events, and one bleeding-related hospitalization. Ventricular pacing, undetermined rhythms, and tachycardia were key predictors of misclassification. These findings highlight the limitations of automated ECG analysis and support structured cardiologist over-read to safeguard against diagnostic errors and improve patient outcomes in AF detection.
One of the most difficult but important steps in assessing the fetus's health is the diagnosis of fetal cardiac abnormalities using fetal electrocardiograms (FECG). In order to provide accurate information regarding the...One of the most difficult but important steps in assessing the fetus's health is the diagnosis of fetal cardiac abnormalities using fetal electrocardiograms (FECG). In order to provide accurate information regarding the fetus's condition, FECG monitoring is required. Severe fetal arrhythmia can cause heart failure or even death. This paper presents a Non-Causal Adaptive Filter that extracts the FECG through multiple error estimation. The maternal channel ECG in the chest will be used as the reference input, and the abdominal ECG will be used as the primary input for this filter. The clean FECG signals will be transformed into time-frequency (T-F) images using a fractional Stockwell transform after the FECG signals have been extracted. Using the Stockwell and fractional Fourier transforms, it can simultaneously display the time and fractional-frequency data in the time-fractional-frequency plane. The ability to detect fetal ECG arrhythmias with a clear physical interpretation is more significant. The resulting images are fed into the Atrous Convolutions aided Vision Transformer based Capsule Network (AConvVTCapNet) model, which detects fetal ECG arrhythmias. In this instance, Atrous convolutions efficiently compute dense feature maps, allowing the network to have wider receptive fields. The proposed model's parameters are adjusted using a new Opposition based Fire Hawk Optimization (OFHO) technique, which is carried out by the capsule network during the classification process. The proposed method obtained 98.23 % accuracy and 98.25 % specificity in the fetal ECG arrhythmia detection process.
DiGirolamo GJ, Kakouros N, Sorcini F
… +4 more, Sorcini SP, Dupell J, Sands EK, Rosen MP
J Electrocardiol
· 2025 · PMID 41135156
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Full text
OBJECTIVE: To investigate errors in the assessment of ST-elevation (STEs) myocardial infarctions on ECGs to determine if non-conscious processes successfully detect missed STEs, as evidenced by changes in how long and of...OBJECTIVE: To investigate errors in the assessment of ST-elevation (STEs) myocardial infarctions on ECGs to determine if non-conscious processes successfully detect missed STEs, as evidenced by changes in how long and often physicians look at leads with STEs. MATERIALS AND METHOD: Eight experienced physicians interpreted 90 ECGs (45 STEs, 45 Normal) while eye movements were recorded. Physicians marked consciously recognized or considered STEs. No clinical context was provided. RESULTS: Physicians missed 18% of STEs. Eye-tracking showed longer (P = 0.02), more frequent (P = 0.02), and increased transitions (P = 0.02) to "missed" STE leads compared to Normal ECG leads. DISCUSSION: Non-conscious detection of STEs, including inter‑lead relationships, despite a lack of conscious recognition, suggests a sophisticated mechanism of wholistic detection, including culprit lesion sites by non-conscious processes. CONCLUSION: Non-conscious detection of STEs supports non-conscious detection processing in medicine leading to more success than can be tracked by conscious report. Eye-tracking could enhance ECG interpretation and reduce diagnostic errors.
BACKGROUND AND PURPOSE OF THE STUDY: Assessing pediatric ECG variations to enhance screening accuracy, thus helps address challenges in distinguishing normal developmental changes from potential cardiac pathology. This s...BACKGROUND AND PURPOSE OF THE STUDY: Assessing pediatric ECG variations to enhance screening accuracy, thus helps address challenges in distinguishing normal developmental changes from potential cardiac pathology. This study aims to establish age- and sex-specific ECG reference patterns in healthy young athletes to improve clinical interpretation during pre-participation screening, thereby reducing false positives and optimizing referral practices. RESULTS: Of 320 patients evaluated at a cardio sports clinic, 243 healthy participants (114 aged 5-9 years; 129 aged 10-16 years) were included. No significant sex-based differences were found in age or weight within either age group. In the 10-16-year group, females had significantly higher heart rates (p = 0.020), while males had longer PR intervals (p = 0.011); no significant differences were observed in QTc or QRS durations. All participants demonstrated normal sinus rhythm and QRS axis. T-wave inversion patterns, commonly seen in leads V1-V3 among 5-9-year-olds and isolated to V1 in 10-16-year-olds. ECG abnormalities such as prolonged QTc or Wolff-Parkinson-White (WPW) pattern were infrequent, with only respiratory sinus arrhythmia being significantly more common in older females (p = 0.035). CONCLUSION: The findings highlight the clinical implication of considering age and sex when interpreting pediatric ECGs, particularly in the context of sports screening. While most parameters showed no significant differences, the observed variations in heart rate and PR interval in older children suggest that sex-specific reference values may be beneficial in clinical practice.
BACKGROUND: Differences in electrocardiogram (EKG) measurements exist between cisgender men and cisgender women, with men typically exhibiting shorter QTc intervals, longer QRS durations, and longer PR intervals. Limited...BACKGROUND: Differences in electrocardiogram (EKG) measurements exist between cisgender men and cisgender women, with men typically exhibiting shorter QTc intervals, longer QRS durations, and longer PR intervals. Limited data describe the effects of gender-affirming hormone replacement therapy (HRT) on EKG parameters in transgender individuals. OBJECTIVE: To evaluate electrocardiographic changes associated with HRT in transgender patients. METHODS: This retrospective, single-institution cohort study included transgender women and transgender men receiving estrogen or testosterone HRT with available pre- and post-HRT EKGs. Demographics and EKG measurements were collected and compared using paired t-tests and Wilcoxon signed-rank tests. RESULTS: Thirty patients met inclusion criteria (17 transgender women, 13 transgender men). Among transgender women, QRS duration decreased from a median of 96.0 (92.0-106.0) ms pre-HRT to 94.0 (86.0-100.0) ms post-HRT (p = 0.022). P-wave amplitude decreased in leads V-V (p = 0.024, p = 0.037), and R-wave amplitude decreased in leads V-V (p = 0.008, p = 0.025, p = 0.011, respectively) post-HRT. T-wave amplitude was lower in transgender women in lead V (p = 0.016) and higher in transgender men in leads V-V post-HRT (p = 0.015, p = 0.024). Stratification by race showed an increase in heart rate in Black transgender women from 71.6 ± 12.8 to 84.9 ± 19.2 beats per minute post-HRT (p = 0.015). Similar differences in P-, R-, and T-wave amplitude were observed in Black transgender patients in select precordial leads. CONCLUSION: HRT used for gender-affirming care is associated with electrocardiographic changes that trend toward patterns of the affirmed gender. Findings suggest baseline and follow-up EKGs should be standardized when initiating HRT. Larger studies are needed to clarify structural and arrhythmogenic implications.
AIMS OF THE STUDY: ST-segment depression in the electrocardiogram (ECG) of acute coronary syndrome (ACS) patients has been associated with higher mortality. But still, its association to sudden cardiac deaths (SCDs) or s...AIMS OF THE STUDY: ST-segment depression in the electrocardiogram (ECG) of acute coronary syndrome (ACS) patients has been associated with higher mortality. But still, its association to sudden cardiac deaths (SCDs) or sudden cardiac arrests (SCAs) has not yet been investigated. We analyzed the association between ST-segment depression in the ECG after angiography and the long-term incidence of SCD and SCA among ACS patients. METHODS: Retrospective data of 8565 consecutive ACS patients with a median follow-up time of 7.1 years were analyzed retrospectively. Patients with (n = 1957) and without (n = 6608) ST-segment depression in ECG after angiography were compared after stratification according to the location of ST-segment depression. Incidents of SCDs and SCAs were adjudicated using various sources detailing the circumstances leading to the events. Subdistribution regression (Fine-Gray) models were used in the association analyses. RESULTS: Lateral, inferior, and inferolateral ST-segment depression were associated with the long-term risk for SCD and SCA in age- and sex-adjusted analyses (p-value <0.05). However, only lateral ST-segment depression was associated with a higher risk for SCD (HR 1.58, 95 % CI 1.13-2.20, p-value 0.007) and SCA (HR 1.48, 95 % CI 1.12-1.96, p-value 0.006) when additionally adjusted with several cardiovascular risk factors. The results remained significant in lateral and inferolateral ST-segment depression even after excluding patients with LVEF ≤35 % at baseline. CONCLUSION: Lateral, inferolateral, and inferior ST-segment depressions in ECG after angiography in ACS patients are associated with a significantly higher long-term risk for SCD and SCA.