Beckerman et al evaluated ST segment and T wave abnormalities in the resting electrocardiogram as they relate to risk of cardiovascular mortality. These can help to identify patients who may benefit from more aggressive management. The authors are from Stanford University and the Veterans Affairs Palo Alto Health Care System.
Patient selection: adult veteran with resting ECG
Patient exclusion: bundle branch block (BBB), left ventricular hypertrophy (LVH), electronic pacing, diagnostic Q waves, Wolff-Parkinson-White (WPW) syndrome
Computer assessment of ECG: Minnesota coding
Outcome: cardiovascular mortality
Parameters:
(1) T wave abnormalities (minor = 5-3 or 5-4; major = 5-1 or 5-2)
(2) ST segment depression (minor = 4-3; major = 4-1 or 4-2).
T Wave Abnormality |
ST Segment Depression |
Relative Risk |
none |
none |
1 |
|
minor |
nonsignificant |
|
major |
nonsignificant |
minor |
none |
1.9 |
|
minor |
1.8 |
|
major |
2.0 |
major |
none |
nonsignificant |
|
minor |
3.2 |
|
major |
3.3 |
where:
• The risk if there was a minor T-wave abnormality is around 2.
The conclusions are that both ST segment depression and T-wave abnormalities are independent predictors of cardiovascular death, with T-wave abnormalities being more significant.
Specialty: Cardiology
ICD-10: ,