Are ECG changes in heart-healthy individuals of various ages related to cardiac disease 20 years later?
Background: This research study aimed at assessing the electrocardiographic (ECG) changes caused by ageing in a cohort of healthy subjects with normal echocardiographic examinations.
Methods: A total of 219 healthy individuals (119 males and 100 females) were evaluated for possible arrhythmias with a standard 12-lead resting ECG and 24-h Holter ECG. As the recordings were performed between 1998 and 2000, a 20-year follow-up study was carried out by assessing the local medical records to investigate whether the subjects had experienced any cardiovascular health complications or disease since the baseline assessment.
Results: Eighty-three subjects (45 males and 38 females) presented with pathological ECG findings at baseline. The most common finding on analysis of Holter ECG recordings was premature atrial contractions, and the most severe pathological finding was episodes of ventricular tachycardia (eight subjects). Regarding the analysis of the standard 12-lead ECG, the most common finding was left ventricular hypertrophy, and the most severe pathological findings were ST-T changes and prolongation of the QT interval. Despite other cardiac examinations performed on these patients showing normal results, in combination with a strict inclusion criterion, this study showed that 28% of all subjects had pathological resting 12-lead ECGs at rest and 35% had pathological heart rhythms when assessed by 24-h Holter ECG. At follow-up, 21% of females and 43% of males had presented with ECG abnormalities, and 30% of females and 36% of males had cardiovascular disease. There was hypertension in 45% of females and in 58% of males. However, no association was found between the follow-up findings and ECG changes seen at baseline.
Conclusion: Although most ECG changes found at baseline could be considered as a normal variation, they may progress to more severe heart complications as the subject ages. The results of this study also validate ECG findings of previous studies and underline that diagnostic criteria should be based on gender and age.
- Lindqvist P, Waldenstrom A, Henein M, Morner S, Kazzam E. Regional and global right ventricular function in healthy individuals aged 20-90 years: a pulsed Doppler tissue imaging study: Umea General Population Heart Study. Echocardiography 2005;22:305–14. doi: 10.1111/j.1540-8175.2005.04023.x
- Rijnbeek PR, van Herpen G, Bots ML, Man S, Verweij N, Hofman A, et al. Normal values of the electrocardiogram for ages 16-90 years. J Electrocardiol 2014;47:914–21. doi: 10.1016/j.jelectrocard.2014.07.022
- Andersson S, Osterlind PO, Holmboe G, Windblad B. Twenty-four-hour electrocardiography in a healthy elderly population. Gerontology 1988;34:139–44. doi: 10.1159/000212943
- Bjerregaard P. Premature beats in healthy subjects 40-79 years of age. Eur Heart J 1982;3:493–503. doi: 10.1093/oxfordjournals.eurheartj.a061344
- Fleg JL, Kennedy HL. Cardiac arrhythmias in a healthy elderly population: detection by 24-hour ambulatory electrocardiography. Chest 1982;81:302–7. doi: 10.1378/chest.81.3.302
- Glasser SP, Clark PI, Applebaum HJ. Occurrence of frequent complex arrhythmias detected by ambulatory monitoring: findings in an apparently healthy asymptomatic elderly population. Chest 1979;75:565–8. doi: 10.1378/chest.75.5.565
- Brodsky M, Wu D, Denes P, Kanakis C, Rosen KM. Arrhythmias documented by 24 hour continuous electrocardiographic monitoring in 50 male medical students without apparent heart disease. Am J Cardiol 1977;39:390–5. doi: 10.1016/s0002-9149(77)80094-5
- Chong BH, Pong V, Lam KF, Liu S, Zuo ML, Lau YF, et al. Frequent premature atrial complexes predict new occurrence of atrial fibrillation and adverse cardiovascular events. Europace 2012;14:942–7. doi: 10.1093/europace/eur389
- Dewland TA, Vittinghoff E, Mandyam MC, Heckbert SR, Siscovick DS, Stein PK, et al. Atrial ectopy as a predictor of incident atrial fibrillation: a cohort study. Ann Intern Med 2013;159:721–8. doi: 10.7326/0003-4819-159-11-201312030-00004
- Martin A, Benbow LJ, Butrous GS, Leach C, Camm AJ. Five-year follow-up of 101 elderly subjects by means of long-term ambulatory cardiac monitoring. Eur Heart J 1984;5:592–6. doi: 10.1093/oxfordjournals.eurheartj.a061710
- Frishman WH, Heiman M, Karpenos A, Ooi WL, Mitzner A, Goldkorn R, et al. Twenty-four-hour ambulatory electrocardiography in elderly subjects: prevalence of various arrhythmias and prognostic implications (report from the Bronx Longitudinal Aging Study). Am Heart J 1996;132:297–302. doi: 10.1016/s0002-8703(96)90425-1
- Bjerregaard P. Mean 24 hour heart rate, minimal heart rate and pauses in healthy subjects 40–79 years of age. Eur Heart J 1983;4:44–51. doi: 10.1093/oxfordjournals.eurheartj.a061370
- Alperts JS, Thygesen K. Myocardial infarction redefined – a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Eur Heart J 2000;21:1502–13. doi: 10.1053/euhj.2000.2305
- Prineas RJ, Crow RS, Zhang Z. The Minnesota Code manual of electrocardiographic findings. London: Springer-Verlag; 2010.
- Bachman S, Sparrow D, Smith LK. Effect of aging on the electrocardiogram. Am J Cardiol 1981;48:513–16. doi: 10.1016/0002-9149(81)90081-3
- Simonson E. The effect of age on the electrocardiogram. Am J Cardiol 1972;29:64–73. doi: 10.1016/0002-9149(72)90417-1
- Vicent L, Martinez-Selles M. Electrocardiogeriatrics: ECG in advanced age. J Electrocardiol 2017;50:698–700. doi: 10.1016/j.jelectrocard.2017.06.003
- Moller CS, Byberg L, Sundstrom J, Lind L. T wave abnormalities, high body mass index, current smoking and high lipoprotein (a) levels predict the development of major abnormal Q/QS patterns 20 years later. A population-based study. BMC Cardiovasc Disord 2006;6:10. doi: 10.1186/1471-2261-6-10
- Molander U, Dey DK, Sundh V, Steen B. ECG abnormalities in the elderly: prevalence, time and generation trends and association with mortality. Aging Clin Exp Res 2003;15:488–93. doi: 10.1007/BF03327371
- Menotti A, Mulder I, Kromhout D, Nissinen A, Feskens EJ, Giampaoli S. The association of silent electrocardiographic findings with coronary deaths among elderly men in three European countries. The FINE study. Acta Cardiol 2001;56:27–36. doi: 10.2143/AC.56.1.2005590
- Tervahauta M, Pekkanen J, Punsar S, Nissinen A. Resting electrocardiographic abnormalities as predictors of coronary events and total mortality among elderly men. Am J Med 1996;100:641–5. doi: 10.1016/s0002-9343(96)00042-3
- Persson M, Carlberg B, Mjorndal T, Asplund K, Bohlin J, Lindholm L, et al. 1999 WHO/ISH Guidelines applied to a 1999 MONICA sample from northern Sweden. J Hypertens 2002;20:29–35. doi: 10.1097/00004872-200201000-00006
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