Isolated non-specific electrocardiographic ST-T abnormalities and risk of incident heart failure and its subtypes.

Abstract (English)

BACKGROUND: Isolated non-specific ST-T abnormalities (NSSTTAs), a common finding on ECGs, were associated with an increased risk of coronary heart disease (CHD) and stroke. However, their association with heart failure (HF) is not well documented. METHODS: This analysis included REasons for Geographic and Racial Differences in Stroke participants who were free of HF, CHD or major ECG abnormalities at baseline (2003-2007). NSSTTAs were defined from baseline ECG using the standards of Minnesota ECG classification. Incident HF events through 2020 were determined from a physician-adjudicated review of hospitalisation medical records and cause of death. Participants with ejection fraction (EF) ≥50% were considered to have HF with preserved EF (HFpEF), and the rest with EF <50% represented HF with either reduced or mildly reduced EF (HFrEF/HFmrEF). Multivariable Cox proportional hazards models examined the association between isolated NSSTTAs and HF. Separate, cause-specific Cox models were used to examine the association with HF subtypes, treating them as competing risks. RESULTS: Among 13 914 participants (mean age: 63.1&#xb1;9.0 years; 60.1% women; 40.0% black), 3859 (28%) had isolated NSSTTAs. Over a median follow-up of 13.5 years (IQR: 7.9-15.6), isolated NSSTTAs were associated with an increased risk of incident HF (HR: 1.83, 95% CI 1.53 to 2.19). Isolated NSSTTAs were associated with an increased risk of both HFrEF/HFmrEF (HR: 2.19; 95% CI 1.64 to 2.93) and HFpEF (HR: 1.66; 95% CI 1.23 to 2.24). CONCLUSIONS: Isolated NSSTTAs were associated with an increased risk of developing both HFrEF/HFmrEF and HFpEF. These findings challenge the assumption that NSSTTAs are benign and suggest their potential role in HF risk stratification.