Electrocardiographic lead aVR is often ignored in clinical practice. The aim of this
study was to investigate whether ST-T wave amplitude in lead aVR predicts cardiovascular
(CV) mortality and if this variable adds value to a traditional risk prediction model.
A total of 7,928 participants enrolled in the National Health and Nutrition Examination
Survey (NHANES) III with electrocardiographic data available were included. Each participant
had 13.5 ± 3.8 years of follow-up. The study sample was stratified according to ST-segment
amplitude and T-wave amplitude in lead aVR. ST-segment elevation (>8 μV) in lead aVR
was predictive of CV mortality in the multivariate analysis when not accounting for
T-wave amplitude. The finding lost significance after including T-wave amplitude in
the model. A positive T wave in lead aVR (>0 mV) was the strongest multivariate predictor
of CV mortality (hazard ratio 3.37, p <0.01). The addition of T-wave amplitude in
lead aVR to the Framingham risk score led to a net reclassification improvement of
2.7% of subjects with CV events and 2.3% of subjects with no events (p <0.01). Furthermore,
in the intermediate-risk category, 20.0% of the subjects in the CV event group and
9.1% of subjects in the no-event group were appropriately reclassified. The absolute
integrated discrimination improvement was 0.012 (p <0.01), and the relative integrated
discrimination improvement was 11%. In conclusion, T-wave amplitude in lead aVR independently
predicts CV mortality in a cross-sectional United States population. Adding T-wave
abnormalities in lead aVR to the Framingham risk score improves model discrimination
and calibration with better reclassification of intermediate-risk subjects.
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Article info
Publication history
Published online: June 13, 2013
Accepted:
April 23,
2013
Received in revised form:
April 23,
2013
Received:
January 3,
2013
Footnotes
Drs. Badheka, Patel, and Grover contributed equally to this work.
See page 810 for disclosure information.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
