Combined Cornell Voltage and Quantitative Assessment of Absolute Area Under ST Segment Predicts Cardiovascular Events in Japanese General Practice Population: J-HOP Study

Introduction: Both ECG-left ventricular hypertrophy diagnosed by Cornell voltage (CV-LVH) and the classic strain pattern or depression of ST segment have been accepted to be associated with adverse prognosis in clinical population. However, there are a few studies about the quantitative assessment of ST segment. Hypothesis: We assessed the hypothesis whether the area under of ST segment (AUST) using computerized measurements as the degree of AUST is associated with cardiovascular events. Methods: We analyzed 834 patients (mean age 63±11years, male 52%) performing ECG of 4310 patients recruited for the J-HOP study. The absolute AUST above or below isoelectric baseline was measured by computer in lead V 5 . Results: After a mean follow up of 6.2 years, there were 58 cardiovascular events. The patients with CV-LVH were suffered more cardiovascular events than those without (Figure A). When we divided patients into quintiles based on AUST, cardiovascular events were significantly increased at the lowest quintile (≤0.084msec•mV) compared with any other groups (Figure B). The group with both CV-LVH and the lowest quintile of AUST had a highest risk of cardiovascular events among 3 groups (Figure C). Multivariate Cox analysis demonstrated that after adjustment for other potential predictors, the combination of CV-LVH and the lowest quintile of AUST had a significant predictor of cardiovascular events compared with those without both CV-LVH and the lowest quintile of AUST (Hazard ratio, 3.25; 95% confidence interval 1.41-7.51, P=0.006) . Conclusions: The combination CV-LVH and absolute area of ST segment was a predictor of cardiovascular events in Japanese general practice population.