Negative U-waves are a relatively rare finding in an electrocardiogram (ECG), but
are often associated with cardiac disease. The prognostic significance of negative
U-waves in the general population is unknown. We evaluated 12-lead ECGs of 6,518 adults
(45% male, mean age 50.9 ± 13.8 years) for the presence of U-waves, and followed the
subjects for 24.5 ± 10.3 years. Primary end points were all-cause mortality, cardiac
mortality, and sudden cardiac death; secondary end point was hospitalization due to
cardiac causes. Negative U-waves (amplitude ≥0.05 mV) were present in 231 subjects
(3.5%), minor negative (amplitude <0.05 mV) or discordant U-waves in 1,004 subjects
(15.4%), normal positive U-waves in 3,950 (60.6%) subjects, and no U-waves were observed
in 603 subjects (9.3%). In 730 subjects (11.2%), U-waves were unassessable. When adjusted
for age and gender, negative U-waves were associated with all end points (p <0.01).
In an analysis adjusted for multiple demographic and clinical factors, in men, negative
U-waves were associated with increased risk of all-cause mortality (hazard ratio [HR]
1.60; 95% confidence interval [CI] 1.26 to 2.03; p <0.001), cardiac mortality (HR
1.74; 95% CI 1.26 to 2.39; p = 0.001), and cardiac hospitalization (HR 1.67; 95% CI
1.27 to 2.18; p <0.001), but not with sudden cardiac death, whereas women did not
show a significant association to any of the end points (p >0.30). In conclusion,
negative U-waves are associated with adverse events in the general population. In
men, this association is independent of cardiovascular risk factors.
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Article info
Publication history
Published online: October 18, 2018
Received in revised form:
October 1,
2018
Received:
July 30,
2018
Footnotes
Funding: This work was supported by Ida Montin Foundation (Kerava, Finland), (AH); Finnish Medical Foundation (Helsinki, Finland), (AH/AE/ALA); Paavo Nurmi Foundation (Helsinki, Finland), (AE); Onni and Hilja Tuovinen's Foundation (Lahti, Finland), (AE); the Orion Research Foundation (Espoo, Finland), (AE/TVK); the Aarne Koskelo Foundation (Helsinki, Finland), (TVK); the Paulo Foundation (Espoo, Finland), (TVK); the Sigrid Juselius Foundation (Helsinki, Finland), (MJJ/HVH/ALA); Academy of Finland (Helsinki, Finland), grant number 267435, (MJJ/HVH); Finnish Foundation for Cardiovascular Research (Helsinki, Finland), (MJJ/HVH); and the Veritas Foundation (Helsinki, Finland), (AE). Funding sources had no involvement in the study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.
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