University of Oulu

Haukilahti MAE, Kenttä TV, Tikkanen JT, Anttonen O, Aro AL, Kerola T, Eranti A, Holkeri A, Rissanen H, Heliövaara M, Knekt P, Junttila MJ and Huikuri HV (2021) Electrocardiographic Risk Markers of Cardiac Death: Gender Differences in the General Population. Front. Physiol. 11:578059. doi: 10.3389/fphys.2020.578059

Electrocardiographic risk markers of cardiac death : gender differences in the general population

Saved in:
Author: Haukilahti, Mira Anette E.1; Kenttä, Tuomas V.1; Tikkanen, Jani T.1;
Organizations: 1Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, Oulu, Finland
2Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
3Division of Cardiology, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
4Heart Center, Central Hospital of North Karelia, Joensuu, Finland
5Department of Public Health Solutions, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.4 MB)
Persistent link:
Language: English
Published: Frontiers Media, 2021
Publish Date: 2021-04-26


Background: Cardiac death is one of the leading causes of death and sudden cardiac death (SCD) is estimated to cause approximately 50% of cardiac deaths. Men have a higher cardiac mortality than women. Consequently, the mechanisms and risk markers of cardiac mortality are not as well defined in women as they are in men.

Aim: The aim of the study was to assess the prognostic value and possible gender differences of SCD risk markers of standard 12-lead electrocardiogram in three large general population samples.

Methods: The standard 12-lead electrocardiographic (ECG) markers were analyzed from three different Finnish general population samples including total of 20,310 subjects (49.9% women, mean age 44.8 ± 8.7 years). The primary endpoint was cardiac death, and SCD and all-cause mortality were secondary endpoints. The interaction effect between women and men was assessed for each ECG variable.

Results: During the follow-up (7.7 ± 1.2 years), a total of 883 deaths occurred (24.5% women, p < 0.001). There were 296 cardiac deaths (13.9% women, p < 0.001) and 149 SCDs (14.8% women, p < 0.001). Among those who had died due to cardiac cause, women had more often a normal electrocardiogram compared to men (39.0 vs. 27.5%, p = 0.132). After adjustments with common cardiovascular risk factors and the population sample, the following ECG variables predicted the primary endpoint in men: left ventricular hypertrophy (LVH) with strain pattern (p < 0.001), QRS duration > 110 ms (p < 0.001), inferior or lateral T-wave inversion (p < 0.001) and inferolateral early repolarization (p = 0.033). In women none of the variables remained significant predictors of cardiac death in multivariable analysis, but LVH, QTc ≥ 490 ms and T-wave inversions predicted SCD (p < 0.047 and 0.033, respectively). In the interaction analysis, LVH (HR: 2.4; 95% CI: 1.2–4.9; p = 0.014) was stronger predictor of primary endpoint in women than in men.

Conclusion: Several standard ECG variables provide independent information on the risk of cardiac mortality in men but not in women. LVH and T-wave inversions predict SCD also in women.

see all

Series: Frontiers in physiology
ISSN: 1664-042X
ISSN-E: 1664-042X
ISSN-L: 1664-042X
Volume: 11
Article number: 578059
DOI: 10.3389/fphys.2020.578059
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: We thank the Juho Vainio Foundation, The Maud Kuistila Memorial Foundation, The Finnish Medical Foundation, Finnish Foundation for Cardiovascular Research, The Paulo Foundation, Aarne Koskelo Foundation, and Päivikki and Sakari Sohlberg Foundation.
Copyright information: © 2021 Haukilahti, Kenttä, Tikkanen, Anttonen, Aro, Kerola, Eranti, Holkeri, Rissanen, Heliövaara, Knekt, Junttila and Huikuri. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.