University of Oulu

Schröder, L. C., Holkeri, A., Eranti, A., Haukilahti, M. A. E., Kerola, T., Kenttä, T. V., Noponen, K., Seppänen, T., Rissanen, H., Heliövaara, M., Knekt, P., Junttila, M. J., Huikuri, H. V., & Aro, A. L. (2022). Poor R-wave progression as a predictor of sudden cardiac death in the general population and subjects with coronary artery disease. Heart Rhythm, 19(6), 952–959.

Poor R-wave progression as a predictor of sudden cardiac death in the general population and subjects with coronary artery disease

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Author: Schröder, Linda C.1; Holkeri, Arttu2; Eranti, Antti3;
Organizations: 1Division of Internal Medicine, Department of Internal Medicine and Rehabilitation, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
2Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
3Heart Center, Central Hospital of North Karelia, Joensuu, Finland
4Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
5Center for Machine Vision and Signal Analysis (CMVS), University of Oulu, Oulu, Finland
6Finnish Institute for Health and Welfare, Helsinki, Finland
7Division of Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.3 MB)
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Language: English
Published: Elsevier, 2022
Publish Date: 2023-06-05


Background: Poor R-wave progression (PRWP) is a common clinical finding on the standard 12-lead electrocardiogram (ECG), but its prognostic significance is unclear.

Objective: The purpose of this study was to examine the prognosis associated with PRWP in terms of sudden cardiac death (SCD), cardiac death, and all-cause mortality in general population subjects with and without coronary artery disease (CAD).

Methods: Data and 12-lead ECGs were collected from a Finnish general population health examination survey conducted during 1978–1980 with follow-up until 2011. The study population consisted of 6854 subjects. Main end points were SCD, cardiac death, and all-cause mortality. PRWP was defined as R-wave amplitude ≤ 0.3 mV in lead V₃ and R-wave amplitude in lead V₂ ≤ R-wave amplitude in lead V₃.

Results: PRWP occurred in 213 subjects (3.1%). During the follow-up period of 24.3 ± 10.4 years, 3723 subjects (54.3%) died. PRWP was associated with older age, higher prevalence of heart failure and CAD, and β-blocker medication. In multivariate analyses, PRWP was associated with SCD (hazard ratio [HR] 2.13; 95% confidence interval [CI] 1.34–3.39), cardiac death (HR 1.75; 95% CI 1.35–2.15), and all-cause mortality (HR 1.29; 95% CI 1.08–1.54). In the subgroup with CAD, PRWP had a stronger association with cardiac mortality (HR 1.71; 95% CI 1.19–2.46) than in the subgroup without CAD, while the association with SCD was significant only in the subgroup with CAD (HR 2.62; 95% CI 1.38–4.98).

Conclusions: PRWP was associated with adverse prognosis in the general population and with SCD in subjects with CAD.

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Series: Heart rhythm
ISSN: 1547-5271
ISSN-E: 1556-3871
ISSN-L: 1547-5271
Volume: 19
Issue: 6
Pages: 952 - 959
DOI: 10.1016/j.hrthm.2022.02.010
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This work was supported by the Orion Research Foundation (to Dr Holkeri) and the Sigrid Jusélius Foundation (to Drs Aro and Holkeri). Funding sources were not involved in the study design; in the data collection, analysis, or interpretation; in the writing of the report; or in the decision to submit the article for publication.
Copyright information: © 2022 Heart Rhythm Society. This is an open access article under the CC BY license (