Risk of sudden cardiac death associated with QRS, QTc, and JTc intervals in the general population

BACKGROUND QRS duration and corrected QT (QTc) interval have been associated with sudden cardiac death (SCD), but no data are available on the significance of repolarization component (JTc interval) of the QTc interval as an independent risk marker in the general population. OBJECTIVE In this study, we sought to quantify the risk of SCD associated with QRS, QTc, and JTc intervals. METHODS This study was conducted using data from 3 population cohorts from different eras, comprising a total of 20,058 individuals. The follow-up period was limited to 10 years and age at baseline to 30-61 years. QRS duration and QT interval (Bazett's) were measured from standard 12-lead electrocardiograms at baseline. JTc interval was defined as QTc interval - QRS duration. Cox proportional hazards models that controlled for confounding clinical factors identified at baseline were used to estimate the relative risk of SCD. RESULTS During a mean period of 9.7 years, 207 SCDs occurred (1.1 per 1000 person-years). QRS duration was associated with a significantly increased risk of SCD in each cohort (pooled hazard ratio [HR] 1.030 per 1-ms increase; 95% confidence interval [CI] 1.017-1.043). The QTc interval had borderline to significant associations with SCD and varied among cohorts (pooled HR 1.007; 95% CI 1.001-1.012). JTc interval as a continuous variable was not associated with SCD (pooled HR 1.001; 95% CI 0.996-1.007). CONCLUSION Prolonged QRS durations and QTc intervals are associated with an increased risk of SCD. However, when the QTc interval is deconstructed into QRS and JTc intervals, the repolarization component (JTc) appears to have no independent prognostic value.Peer reviewe

Risk of sudden cardiac death associated with QRS, QTc, and JTc intervals in the general population

BackgroundQRS duration and corrected QT (QTc) interval have been associated with sudden cardiac death (SCD), but no data are available on the significance of repolarization component (JTc interval) of the QTc interval as an independent risk marker in the general population.ObjectiveIn this study, we sought to quantify the risk of SCD associated with QRS, QTc, and JTc intervals.MethodsThis study was conducted using data from 3 population cohorts from different eras, comprising a total of 20,058 individuals. The follow-up period was limited to 10 years and age at baseline to 30–61 years. QRS duration and QT interval (Bazett’s) were measured from standard 12-lead electrocardiograms at baseline. JTc interval was defined as QTc interval – QRS duration. Cox proportional hazards models that controlled for confounding clinical factors identified at baseline were used to estimate the relative risk of SCD.ResultsDuring a mean period of 9.7 years, 207 SCDs occurred (1.1 per 1000 person-years). QRS duration was associated with a significantly increased risk of SCD in each cohort (pooled hazard ratio [HR] 1.030 per 1-ms increase; 95% confidence interval [CI] 1.017–1.043). The QTc interval had borderline to significant associations with SCD and varied among cohorts (pooled HR 1.007; 95% CI 1.001–1.012). JTc interval as a continuous variable was not associated with SCD (pooled HR 1.001; 95% CI 0.996–1.007).ConclusionProlonged QRS durations and QTc intervals are associated with an increased risk of SCD. However, when the QTc interval is deconstructed into QRS and JTc intervals, the repolarization component (JTc) appears to have no independent prognostic value.</p

Early repolarization in the inferolateral leads of the electrocardiogram:prevalence, prognosis and characteristics

Abstract “Early repolarization” (ER), consisting of J waves and ST-segment elevation in the standard 12-lead electrocardiogram (ECG), has been considered a benign finding for over 60 years until 2008 an over-presentation of ER ECG pattern in infero-lateral leads was described in patients with idiopathic ventricular fibrillation. The purpose of this thesis was to assess the prevalence and prognostic significance, and to characterize the clinical features of this ECG pattern primarily in the general population. This thesis investigated the electrocardiographic features of a total of 20,308 general population individuals, 565 athletes, 432 victims of sudden cardiac death and 532 survivors of an acute coronary event. The overall prevalence of infero-lateral ER ECG pattern in the general population samples was in range between 3.3 and 6.1 percent. ER seemed to have a heritable basis as siblings of individuals displaying the ER pattern had significantly increased odds for presenting this ECG pattern. Several strong associations between ER pattern and clinical factors were observed in all populations. The ER patterns with horizontal or descending ST-segments were associated with significantly increased arrhythmic mortality during a follow-up of 30±11 years, and high amplitude (&#62;0.2mV) J waves in the inferior leads were associated with a high risk of arrhythmic death (multivariate adjusted hazard ratio 3.13 (95% confidence interval 1.55 to 6.32). The ER ECG pattern was also independently associated with sudden cardiac death during an acute coronary event, with an odds ratio of 2.02 (95% CI 1.04 to 3.61) for suffering sudden death. The ER patterns with rapidly ascending ST-segments, the dominant type of ER ECG in young, healthy individuals, were not associated with any adverse outcomes. A multicentre meta-analysis of genome wide association study of ER ECG pattern performed in a total of 14,633 individuals pointed to an associated locus in KCND3 (Kv4.3) gene, which encodes a subunit of the Ito channel, but the association did not reach genome-wide significance and could not be replicated in all study populations. In conclusion, the results of these studies demonstrated that the ER ECG pattern with horizontal or descending ST-segments, especially in the inferior leads, is associated with an increased risk of sudden arrhythmic death in the general population, and that individuals carrying this ECG pattern are at increased risk of suffering fatal arrhythmia during an acute coronary event. The ER pattern with rapidly ascending ST-segments is common in young healthy athletes and is not associated with any increased risk of fatal events. Although the ER ECG pattern increases the relative risk of arrhythmic events, the absolute risk in an individual is low and therefore this ECG pattern should not be interpreted as a high-risk marker of mortality. The genetic background of this ECG pattern remains to be clarified.Tiivistelmä Normaalissa 12-kytkentäisessä sydänfilmissä (EKG) J-aallosta ja ST-segmentin noususta koostuvaa varhaista repolarisaatiota (ER) pidettiin yli 60 vuotta hyvänlaatuisena muutoksena, kunnes vuonna 2008 ER:n esiintyminen alaseinä-lateraalikytkennöissä liitettiin idiopaattiseen kammiovärinään. Tämän väitöstutkimuksen tarkoitus oli selvittää EKG muutoksen esiintyvyys ja ennustearvo normaaliväestössä, sekä selvittää sen kliinisiä erityispiirteitä. Väitöstutkimusta varten tutkittiin 20,308 normaaliväestön henkilöä, 565 urheilijaa, 432 äkillisesti (sydänperäisesti) menehtynyttä henkilöä ja 532 akuutista sepelvaltimotautikohtauksesta selviytynyttä potilasta. ER-EKG:n kokonaisesiintyvyys alaseinä-lateraalikytkennöissä normaaliväestön otoksissa vaihteli 3.3&#160;% ja 6.1&#160;% välillä. ER-EKG:n esiintyessä merkittävästi muita useammin sisaruksilla ER-EKG vaikutti periytyvältä muutokselta, ja lisäksi kaikissa otoksissa ER-EKG liittyi useisiin muihin tunnettuihin kliinisiin muuttujiin. ER-EKG, ts. J-aallot, joita seurasivat horisontaalinen tai laskeva ST-segmentti, liittyivät merkittävästi lisääntyneeseen rytmihäiriökuolleisuuteen pitkän seuranta-ajan (30±11 vuotta) aikana, ja korkea-amplitudiset (&#62;0.2mV) J-aallot alaseinäkytkennöissä liittyivät korkeaan riskiin kuolla äkillisesti rytmihäiriöön (monimuuttuja-vakioitu riskisuhde 3.13, 95&#160;% luottamusväli 1.55–6.32). ER-EKG lisäsi lisäksi itsenäisesti sydänperäisen äkkikuoleman riskiä akuutin sepelvaltimotautikohtauksen aikana (vetosuhde 2.02, 95&#160;% luottamusväli 1.04–3.61). Etenkin nuorilla ja terveillä urheilijoilla esiintynyt EKG tyyppi, J-aallot ST-segmentin nousujen yhteydessä, ei liittynyt huonoon ennusteeseen. Monikeskusmeta-analyysi perimänlaajuisista assosiaatiotutkimuksista (GWAS) 14,633 henkilöllä antoi viitteitä geenimuutoksesta KCND3, joka koodittaa osaa Ito kanavasta, mutta löydöstä ei kyetty toistamaan kaikissa tutkituissa aineistoissa. Väitöstutkimuksen osatöiden perusteella ER-EKG muutos ilman ST-segmentin nousua, erityisesti alaseinäkytkennöissä esiintyessään, liittyy normaaliväestössä lisääntyneeseen riskiin sydänperäiselle rytmihäiriökuolemalle, ja että henkilöillä, joilla muutos esiintyy, on lisääntynyt riski menehtyä äkillisesti sepelvaltimotautikohtauksen aikana. ER-EKG ST-segmentin nousuihin liittyen on yleinen löydös nuorilla terveillä urheilijoilla ja se ei näytä liittyvän lisääntyneeseen riskiin rytmihöiriöille. Vaikka ER-EKG lisääkin suhteellista riskiä rytmihäiriöille ja ennenaikaiselle kuolemalle väestötasolla, absoluuttinen riski on pieni, eikä muutosta tulisi luokitella suureksi riskitekijäksi. Löydöksen geneettinen tausta on vielä avoin kysymys

Improving data quality, applicability and transparency of national water accounts - A case study for Finland

Highlights • A procedure for the compilation of the highly disaggregated national water accounts, and a data quality framework is described. • Sectoral data coverages and sources of error are reported and discussed. • Water accounts for self-abstracted water and mains-water are reported for 195 industries of the Finnish economy. • The accounts are primarily based on actual water supply and use rate data. • Data are reported separately for mains water, groundwater, fresh surface water, brackish water, and cooling water.This paper introduces a novel procedure for the compilation of highly disaggregated water accounts by using Finland as a case example. The procedure is based on combining the use of existing standard economic statistics and other registers and databases with a dataset on water supply and use collected in the present study. As an outcome, water supply and use accounts are presented for 195 industries in the Finnish economy in 2010. The water accounts presented are based primarily on actual water supply and use rates and distinguish between various raw water sources and uses: groundwater, fresh surface, brackish water self-abstracted for own use, and mains-water supply and use. Separate accounts for cooling water are presented. The paper covers flow accounts from the environment to the economy and within the economy excluding all return flows. Data coverage issues and potential sources of error are reported in detail and discussed together with the applicability of the procedure in other countries. Implications for the System of Economic-Environmental Accounting for Water (SEEA-Water) framework are assessed

International evaluation of research at the University of Oulu:Research Assessment Exercise RAE2020: executive summary

Abstract At the University of Oulu (UOULU) we work as part of the international science community to produce new scientific information and science-based solutions. We also train future pioneers to build a more sustainable, intelligent and humane world. We are committed to promoting the United Nations´ goals of sustainable development with our research and education. UOULU was founded in 1958. Today, with 3400 employees and 13500 students in eight faculties, it is one of the largest and the most multidisciplinary universities in Finland, encompassing fields of a classical university as well as technology and economics and business (Fig. 1.1.). The University of Oulu is an active partner for collaboration. We collaborate in many ways with our stakeholders to meet the changing demands of information and working life, and to promote well-being and competitiveness in society. University´s experts and scientific expertise, research services and equipment are available to UOULU’s partners. To this end, this RAE2020 executive summary report provides an overview of the research in UOULU and its quality. The RAE2020 evaluation of research units (RU, organizational unit joining closely allied research groups) was performed by three international panels, consisting of 9‐11 international experts representing the relevant scientific fields of each panel. The data provided by and for each RU formed the basis for assigning each RU to one of the three evaluation panels. The information provided for the panels were a self-evaluation and scientific action plan report provided by the RUs. In addition, the panels interviewed the RUs remotely. To support RUs in their own self-assessment and the panellists in their evaluation, publications by UOULU scientists were analyzed. The publications for the 2013‐2017 period were analysed in two parts: by the Centre for Science and Technology Studies (CTWS) from Leiden University and by the Oulu University Library. Besides the university and RU level analyses, we now have for the first time a coherent view of how the RUs are related to the university´s focus areas and profiling themes, and how RUs’ scientific action plans relate to the United Nations’ Sustainable Development Goals (UN SDG). The panels noted together that the RUs of the UOULU engage actively in research and achieve extremely high standards, with several being world leading. Further, the defined five focus areas of UOULU give the university a unique profile. These focus areas are directly related to the UN SDGs. The RUs are aligned very well with these focus areas and use them for developing ambitious, yet feasible strategic plans. The RAE2020 evaluation provides valuable input to re-evaluation and updating of UOULU’s strategy in the coming years. It offers for the RUs specific opportunity to plan how to achieve excellence in their fields of research and stimulate the multidisciplinary research approaches for building their excellence. UOULU’s strategic vision to target its expertise to build a more sustainable, intelligent and humane world is well justified based on the new data. Taina Pihlajaniemi, Vice Rector (research) 26.4.202

ECG left ventricular hypertrophy as a risk predictor of sudden cardiac death

Background: Electrocardiographic (ECG) left ventricular hypertrophy (LVH) is an established risk factor for cardiovascular events. However, limited data is available on the prognostic values of different ECG LVH criteria specifically to sudden cardiac death (SCD). Our goal was to assess relationships of different ECG LVH criteria to SCD. Methods: Three traditional and clinically useful (Sokolow-Lyon, Cornell, RaVL) and a recently proposed (Peguero-Lo Presti) ECG LVH voltage criteria were measured in 5730 subjects in the Health 2000 Survey, a national general population cohort study. Relationships between LVH criteria, aswell as their selected composites, to SCD were analyzed with Cox regression models. In addition, population-attributable fractions for LVH criteria were calculated. Results: After a mean follow-up of 12.5 +/- 2.2 years, 134 SCDs had occurred. When used as continuous variables, all LVH criteria except for RaVL were associated with SCD in multivariable analyses. When single LVH criteria were used as dichotomous variables, only Cornell was significant after adjustments. The dichotomous composite of Sokolow-Lyon and Cornell was also significant after adjustments (hazard ratio for SCD 1.82, 95% confidence interval 1.20-2.70, P = 0.006) and was the only LVH measure that showed statistically significant population attributable fraction (11.0%, 95% confidence interval 1.9-19.2%, P=0.019). Conclusions: Sokolow-Lyon, Cornell, and Peguero-Lo Presti ECG, but not RaVL voltage, are associated with SCD risk as continuous ECG voltage LVH variables. When SCD risk assessment/adjustment is performed using a dichotomous ECG LVH measure, composite of Sokolow-Lyon and Cornell voltages is the preferred option. (c) 2018 The Authors. Published by Elsevier B.V.Peer reviewe

Causes of nonischemic sudden cardiac death in the current era

Previous data have shown that various nonischemic cardiac diseases account for about 20% of sudden cardiac deaths (SCDs) and that dilated and hypertrophic cardiomyopathy (CM) are major causes of nonischemic SCD. The purpose of this study was to define the prevalence and causes of SCD due to nonischemic CM in the current era given the substantial change in the diagnosis and treatment of cardiac diseases and in lifestyle patterns. A total of 2661 consecutive victims of SCD from among a population of approximately 470,000 inhabitants in the Province of Oulu, Northern Finland, were included in the study. The causes of deaths were determined from the uniformly required autopsies of SCD victims in Finland, plus available medical records and standardized questionnaires. Nonischemic cause of SCD was found in 579 victims (21.8% of all the SCDs). Mean age (± SD) was 55 (±12) years; 78% were males. After subgrouping the nonischemic SCDs into various categories, SCDs associated most closely with obesity (23.7%), followed by alcoholic CM (19.0%), hypertensive CM (15.5%), and fibrotic CM (13.6%). Fibrotic CM was the most common association with SCD in subjects younger than 40 years (28.3%), whereas alcoholic CM was the most common cause of death in subjects between 40 and 59 years of age (25.8%). CM related to obesity, fibrotic CM, and alcoholic CM are commonly associated with nonischemic SCD in the current era. The association of SCD with fibrotic CM is notably frequent among victims younger than 40 years