Evaluation of cases with early repolarization on electrocardiogram and normal population in terms of laboratory and clinical results

Abstract

Aim: Early repolarization (ER) is a frequent indication, and it is important to correctly evaluate the effects of its benign and malignant forms in terms of prognosis. It was aimed to compare ER cases with the normal population in terms of multi-vessel disease, bypass and mortality. Material and Method: This study comprised 776 patients aged 18 and older who admitted the emergency department between January 2015 and December 2020. 377 of these patients had ER in the electrocardiogram (ECG), 409 patients had normal ECGs and were added to the study as the control group. Age, gender, multi-vessel disease, by-pass and mortality relations of the patients were evaluated with angiographic findings. Results: The mean age of 786 patients was 50.49±6.82 years, 372 (47.3%) were female, and the age range was 23-66 years (p<0.001). Of the cases, 110 (14%) were in the horizontal ER, 267 (34%) were in the ascending ER, and 409 (52%) were in the normal group. Multi-vessel disease was observed in 58 (7.4%) of all cases (p<0.001), while 19 (2.4%) had a by-pass attempt because angiography could not be cured (p=0.001). Of the cases with early repolarization, 176 (22.4%) were inferior, 112 (14.2%) were inferolateral, 77 (9.8%) were anterior, and a small number of them were 12 (1.5%) common ER types (p<0.001). Angiography was normal in 575 (73.2%) cases, left anterior descending artery was occluded in 65 (8.3%), circumflex artery was occluded in 73 (9.3%) and right coronary artery was occluded in 73 (9.3%) cases (p<0.001). Eighteen (2.3%) patients resulted in mortality in the 60-month follow-up of all cases. Of these, 9 (8.2%) were horizontal, 2 (0.7%) were asending, and 7 (1.7%) were in the normal population (p<0.001). Conclusion: Electrocardiography can be a helpful method to evaluate interventional angiography, prognosis and mortality in both early repolarization cases and normal cases.

Keywords

• Emergency Department
• Early Repolarization
• Angiography
• Multiple vessel disease
• Mortality

References

1. Tikkanen JT, Junttila MJ, Anttonen O, et al. Early repolarization: electrocardiographic phenotypes associated with favorable long-term outcome. Circulation 2011; 123: 2666-73.
2. Rosso R, Kogan E, Belhassen B, et al. J-point elevation in survivors of primary ventricular fibrillation and matched control subjects: incidence and clinical significance. J Am Coll Cardiol 2008; 52: 1231-8.
3. Pérez-Riera AR, Abreu LC, Yanowitz F, Barros RB, Femenía F, McIntyre WF, Baranchuk A. "Benign" early repolarization versus malignant early abnormalities: clinical-electrocardiographic distinction and genetic basis. Cardiol J 2012; 19: 337-46.
4. Gussak I, Antzelevitch C. Early repolarization syndrome: clinical characteristics and possible cellular and ionic mechanisms. J Electrocardiol 2000; 33: 299-309.
5. Fenichel NN. A long-term study of concave RS-T elevationa normal variant of the electrocardiogram. Angiology 1962; 13: 360–6.
6. Klatsky AL, Oehm R, Cooper RA, Udaltsova N, Armstrong MA. The early repolarization normal variant electrocardiogram: correlates and consequences. Am J Med 2003; 115: 171–7.
7. Mizusawa Y, Bezzina CR. Early repolarization pattern: its ECG characteristics, arrhythmogeneity and heritability. J Interv Card Electrophysiol 2014; 39: 185–92.
8. Rosso R, Glikson E, Belhassen B, et al. Distinguishing "benign" from "malignant early repolarization": the value of the ST-segment morphology. Heart Rhythm 2012; 9: 225-9.

9. Nunn LM, Bhar-Amato J, Lowe MD, et al. Prevalence of J-point elevation in sudden arrhythmic death syndrome families. J Am Coll Cardiol 2011; 58: 286-90.
10. Noseworthy PA, Tikkanen JT, Porthan K, et al. The early repolarization pattern in the general population: clinical correlates and heritability. J Am Coll Cardiol 2011; 57: 2284-9.
11. Reinhard W, Kaess BM, Debiec R, Nelson CP, Stark K, Tobin MD, et al. Heritability of early repolarization: a population-based study. Circ Cardiovasc Genet 2011; 2: 134-8.
12. Mahida S, Derval N, Sacher F. Role of electrophysiological studies in predicting risk of ventricular arrhythmia in early repolarization syndrome. J Am Coll Cardiol 2015; 65: 151–9.
13. Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124: 2574–609.
14. Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983; 51: 606.
15. Haïssaguerre M, Derval N, Sacher F, et al. Sudden cardiac arrest associated with early repolarization. N Engl J Med 2008; 358: 2016-23.
16. Benito B, Guasch E, Rivard L, Nattel S. Clinical and mechanistic issues in early repolarization of normal variants and lethal arrhythmia syndromes. J Am Coll Cardiol 2010; 56: 1177-86.
17. Takagi M, Aihara N, Takaki H, et al. Clinical characteristics of patients with spontaneous or inducible ventricular fibrillation without apparent heart disease presenting with J wave and ST segment elevation in inferior leads. J Cardiovasc Electrophysiol 2000; 11: 844-8.
18. Shinohara T, Takahashi N, Saikawa T, Yoshimatsu H. Characterization of J wave in a patient with idiopathic ventricular fibrillation. Heart Rhythm 2006; 3: 1082-4.
19. Nam GB, Ko KH, Kim J, et al. Mode of onset of ventricular fibrillation in patients with early repolarization pattern vs. Brugada syndrome. Eur Heart J 2010; 31: 330-9.
20. Olson KA, Viera AJ, Soliman EZ, Crow RS, Rosamond WD. Long-term prognosis associated with J-point elevation in a large middle-aged biracial cohort: the ARIC study. Eur Heart J 2011; 32: 3098-106.
21. Haruta D, Matsuo K, Tsuneto A, et al. Incidence and prognostic value of early repolarization pattern in the 12-lead electrocardiogram. Circulation 2011; 123: 2931–37.
22. Mehta M, Jain AC, Mehta A. Early repolarization. Clin Cardiol 1999; 22: 59-65.
23. James AF, Choisy SC, Hancox JC. Recent advances in understanding sex differences in cardiac repolarization. Prog Biophys Mol Biol 2007; 94: 265-319.
24. Antzelevitch C, Yan GX, Viskin S. Rationale for the use of the terms J-wave syndromes and early repolarization. J Am Coll Cardiol 2011; 57: 1587-90.
25. Hünük B, Kepez A, Erdoğan O. The prevalence of early repolarization variant in Turkish male subjects: a clinical single center study. Archives of the Turkish Society of Cardiology 2012; 40: 409-13.
26. Wasserburger RH, Alt WJ. The normal RS-T segmentelevationvariant. Am J Cardiol 1961; 8: 184-92.
27. Uberoi A, Jain NA, Perez M, et al. Early repolarization in an ambulatory clinical population. Circulation 2011; 124: 2208-14.
28. Sinner MF, Reinhard W, Müller M, et al. Association of early repolarization pattern on ECG with risk of cardiac and all-cause mortality: a population-based prospective cohort study (MONICA/KORA). PLoS Med 2010; 7: e1000314.