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Nonspecific Ventricular Repolarization Abnormalities: A Benign Finding or a Prognostic Concern?
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 17 - REABILITAÇÃO CARDÍACA: ESTRATIFICAÇÃO DE RISCO, IMPACTO DO EXERCÍCIO E O PAPEL DA EDUCAÇÃO NA MELHORIA DOS RESULTADOS DOS DOENTES
Speaker:
Sofia Andraz
Congress:
CPC 2025
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.2 Risk Factors and Prevention – Cardiovascular Risk Assessment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sofia Andraz; Joana Massa Pereira; Lucas Hamann; Joana Guerreiro Pereira; Miguel Espírito Santo; Pedro de Azevedo; Hugo Costa; Jorge Mimoso
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Times New Roman",serif"><strong>Introduction</strong>: Nonspecific ventricular repolarization abnormalities (NVRA) are minor electrocardiographic changes in the ST segment and/or T wave often described in individuals without apparent heart disease. Although their clinical significance remains uncertain, often no further investigation is pursued, and they are usually disregarded in the absence of accompanying symptoms.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Times New Roman",serif"><strong>Objective</strong>: To assess the impact of NVRA on the prognosis of individuals without established cardiovascular disease (CVD).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Times New Roman",serif"><strong>Methods</strong>: This analysis included 8,561 participants from the Third Report of the National Health and Nutrition Examination Survey who performed an ECG. Individuals with prior CVD or major ECG changes (e.g. QRS ≥120 ms, pathological Q waves or non-sinus rhythm) were excluded from the analysis. NVRAs were defined as subtle T wave changes (<1mm) and/or ST-segment depression <0.5mm. Relevant demographic, clinical and laboratorial data were compared between patients with and without NVRAs. The prognostic impact of NVRAs on all-cause and cardiovascular mortality was assessed using a Cox regression model to adjust for cofounders. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Times New Roman",serif"><strong>Results</strong>: A total of 6,766 participants were included, of which 739 (12%) had NVRAs.. This group was older (mean age 62.6 ± 12.5 vs. 57.4 ± 12.9 years, p < 0.001), less frequently male (38.6% vs. 45.9%, p < 0.001) or of white race (65.1% vs. 74.6%, p < 0.001). This group had higher rates of hypertension (67.4% vs. 41.4%, p < 0.001), diabetes mellitus (21.9% vs. 14.8%, p < 0.001), dyslipidemia (24.0% vs. 23.1%, p < 0.001) and higher BMI (28.2 vs. 26.7 kg/m², p < 0.001). After a mean follow-up of of 18.6 ± 7.3 years, the overall all-cause mortality rate in the cohort was 49.2%, and CV mortality was 13.1%. The NVRA group experienced significantly higher all-cause mortality (64.1% vs. 47.2%, p < 0.001) and CV mortality (19.8% vs. 12.2%, p < 0.001) compared to the non-NVRA group. In multivariate Cox regression analysis, NVRA remained significantly associated with increased all-cause mortality (HR 1.21, 95% CI 1.06–1.40, p=0.006), but not CV mortality (HR 1.20, 95% CI 0.91-1.59, p=0.180). Conventional CV risk factors were predictors of both all-cause and CV mortality.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Times New Roman",serif"><strong>Conclusions</strong>: NVRAs are associated with higher all-cause mortality in individuals without CVD, indicating that NVRA may not be a benign finding and instead serve as a useful marker for poor overall prognosis. The clinical relevance of NVRA in relation to cardiovascular events remains unclear and warrants further investigation.</span></span></p>
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