Prognostic Assessment of Early Repolarization/J Wave Electrocardiographic Pattern in Patients With Stable Ischemic Heart Disease

• Published in: The American journal of cardiology 2023-01, Vol.186, p.236-242
• Main Authors: Lanza, Gaetano A., Bisignani, Antonio, Melita, Veronica, Telesca, Alessandro, Tremamunno, Saverio, Cambise, Nello, De Vita, Antonio, Lanza, Oreste, Mollo, Roberto
• Format: Article
• Language: English
• Subjects: Aged; Arrhythmias, Cardiac - diagnosis; Cardiac stress tests; Cardiovascular disease; Cardiovascular diseases; Confidence intervals; Coronary vessels; Death; EKG; Electrocardiography; Heart; Heart Conduction System; Heart diseases; Humans; Hypertension; Ischemia; Male; Middle Aged; Morphology; Mortality; Myocardial infarction; Myocardial Infarction - diagnosis; Patients; Prognosis; Survival analysis; Tomography; Vein & artery diseases; Ventricle
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2022.10.008

Recent studies suggested that early repolarization (ER)/J wave at the electrocardiogram (ECG) is associated with increased risk of sudden death and ventricular arrhythmias in patients with acute myocardial infarction. In this study, we prospectively assessed whether ER/J wave has any long-term prognostic implications in patients with stable ischemic heart disease (IHD). We enrolled consecutive clinically stable patients with documented IHD, referred to undergo a routine ECG. ER (typical concave ST-segment elevation) and J wave were diagnosed according to prospectively defined criteria. The final population included 617 patients with documented IHD (455 men; age 68.1 ± 11 years). ER/J wave was found in 138 patients (22.4%), 13 of whom (2.1%) showed ER and 133 (21.6%) a J wave. At a follow-up of 8.1±2.9 years, 160 deaths occurred (25.9%), 60 (9.7%) attributed to cardiovascular causes. Total mortality was lower in patients with versus those without ER/J wave (18.8% vs 28.0%; hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.40 to 0.93, p = 0.02). The difference, however, was not significant after adjustment for confounding clinical variables (HR 0.78, 95% CI 0.51 to 1.19, p = 0.25). No significant difference was found in cardiovascular death between patients with (7.2%) and those without (10.4%) ER/J wave (adjusted HR 0.78, 95% CI 0.40 to 1.55, p = 0.48). Similar results were obtained for ER and J wave separately, and for ECG location of ER/J wave (inferior or lateral/precordial) and type of J wave (notched or slurred). The ER/J wave pattern at the ECG is not associated with increased risk of long-term mortality in clinically stable patients with a documented history of IHD.