Skip to main content

Advertisement

Log in

The Role of Resting Electrocardiogram in Screening for Primary Prevention of Cardiovascular Diseases in High-Risk Groups

  • Novel and Emerging Risk Factors (K. Nasir, Section Editor)
  • Published:
Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We sought to determine whether a role existed for the screening of certain populations with electrocardiogram (ECG) to improve risk stratification and facilitate risk reduction for primary prevention.

Recent Findings

Current screening guidelines do not recommend ECG screening for the general population.

Summary

While current guidelines, based on the available evidence, do not recommend ECG screening for the general population, in this report, we show that certain groups such as the elderly, those with hypertension, diabetes, or chronic kidney disease, may benefit from screening as a cost-effective means for identifying those at risk for future cardiovascular disease events. However, future studies are needed to standardize ECG markers and further qualify the screening value in these populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. WHO EMRO | Health promotion and disease prevention through population-based interventions, including action to address social determinants and health inequity | Public health functions | About WHO. http://www.emro.who.int/about-who/public-health-functions/health-promotion-disease-prevention.html. Accessed December 8, 2017.

  2. Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, et al. Current methods of the US preventive services task force: a review of the process. Am J Prev Med. 2001;20(3 Suppl):21–35. http://www.ncbi.nlm.nih.gov/pubmed/11306229. Accessed December 9, 2017.

    Article  CAS  PubMed  Google Scholar 

  3. Seballos RJ. Principles of Screening. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/preventive-medicine/principles-of-screening/. Published 2010. Accessed December 9, 2017.

  4. Chou R, Qaseem A, Biebelhausen J, et al. Cardiac screening with electrocardiography, stress echocardiography, or myocardial perfusion imaging: advice for high-value care from the american college of physicians. Ann Intern Med. 2015;162(6):438–47. https://doi.org/10.7326/M14-1225.

    Article  PubMed  Google Scholar 

  5. Chou R, Arora B, Dana T, Fu R, Walker M, Humphrey L. Screening asymptomatic adults with resting or exercise electrocardiography: a review of the evidence for the U.S. preventive services task force. Ann Intern Med. 2011;155(6):375–85. https://doi.org/10.1059/0003-4819-155-6-201109200-00006.

    Article  PubMed  Google Scholar 

  6. •• Shah AJ, Vaccarino V, Janssens ACJW, et al. An electrocardiogram-based risk equation for incident cardiovascular disease from the National Health and nutrition examination survey. JAMA Cardiol. 2016;1(7):779. https://doi.org/10.1001/jamacardio.2016.2173. A well-developed ECG risk equation based on various ECG parameters and patient demographics.

    Article  PubMed  Google Scholar 

  7. Cuspidi C, Rescaldani M, Sala C, Negri F, Grassi G, Mancia G. Prevalence of electrocardiographic left ventricular hypertrophy in human hypertension. J Hypertens. 2012;30(11):2066–73. https://doi.org/10.1097/HJH.0b013e32835726a3.

    Article  CAS  PubMed  Google Scholar 

  8. Denes P, Larson JC, Lloyd-Jones DM, Prineas RJ. Greenland P. major And minor ECG abnormalities in asymptomatic women and risk of cardiovascular events and mortality. JAMA. 2007;297(9):978–85. https://doi.org/10.1001/jama.297.9.978.

    Article  CAS  PubMed  Google Scholar 

  9. Tervahauta M, Pekkanen J, Punsar S, Nissinen A. Resting electrocardiographic abnormalities as predictors of coronary events and Total mortality among elderly men. Am J Med. 1996;100:641–5. https://ac-els-cdn-com.go.libproxy.wakehealth.edu/S0002934396000423/1-s2.0-S0002934396000423-main.pdf?_tid=d7dfb3e0-cb27-11e7-83ac-00000aacb35d&acdnat=1510875944_bb400814c1a2f49fcaa5416d9ccf88d2. Accessed November 16, 2017.

    Article  CAS  PubMed  Google Scholar 

  10. Viskin S. Long QT syndromes and tornado de pointes. Lancet. 1999;354:1625–33. https://doi.org/10.1016/S0140-6736(99)02107-8.

    Article  CAS  PubMed  Google Scholar 

  11. • Bang CN, Devereux RB, Okin PM. Regression of electrocardiographic left ventricular hypertrophy or strain is associated with lower incidence of cardiovascular morbidity and mortality in hypertensive patients independent of blood pressure reduction – a LIFE review. J Electrocardiol. 2014;47:630–5. https://doi.org/10.1016/j.jelectrocard.2014.07.003. The LIFE study showed an association between ECG strain in patients with LVH and increased cardiovascular events in hypertensive patients.

    Article  PubMed  Google Scholar 

  12. Mahmood SS, Levy D, Vasan RS, Wang TJ. The Framingham heart study and the epidemiology of cardiovascular diseases: a historical perspective. Lancet. 2014;383(9921):999–1008. https://doi.org/10.1016/S0140-6736(13)61752-3.

    Article  PubMed  Google Scholar 

  13. Van Biesen W, De Bacquer D, Verbeke F, Delanghe J, Lameire N, Vanholder R. The glomerular filtration rate in an apparently healthy population and its relation with cardiovascular mortality during 10 years. Eur Heart J. 2007;28(4):478–83. https://doi.org/10.1093/eurheartj/ehl455.

    Article  PubMed  Google Scholar 

  14. Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97(18):1837–47. https://doi.org/10.1161/01.cir.97.18.1837.

    Article  CAS  PubMed  Google Scholar 

  15. Anderson KM, Wilson PW, Odell PM, Kannel WB. An updated coronary risk profile. A statement for health professionals. Circulation. 1991;83(1):356–62. https://doi.org/10.1161/01.CIR.83.1.356.

    Article  CAS  PubMed  Google Scholar 

  16. • Deo R, Shou H, Soliman EZ, Yang W, Arkin JM, Zhang X, et al. Electrocardiographic measures and prediction of cardiovascular and noncardiovascular death in CKD. J Am Soc Nephrol. 2016;27(2):559–69. https://doi.org/10.1681/ASN.2014101045. CKD patients with increased ECG intervals (PR, QRS, QTc) correlate with adverse cardiovascular events.

    Article  CAS  PubMed  Google Scholar 

  17. • Drawz PE, Babineau DC, Brecklin C, He J, Kallem RR, Soliman EZ, et al. Heart rate variability is a predictor of mortality in chronic kidney disease: a report from the CRIC study. Am J Nephrol. 2013;38(6):517–28. https://doi.org/10.1159/000357200. Type 1 diabetics are linked to increased cardiovascular outcomes.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Soliman EZ, Backlund J-YC, Bebu I, Orchard TJ, Zinman B, Lachin JM, et al. Electrocardiographic abnormalities and cardiovascular disease risk in type 1 diabetes: the epidemiology of diabetes interventions and complications (EDIC) study. Diabetes Care. 2017;40(6):793–9. https://doi.org/10.2337/dc16-2050.

    Article  PubMed  Google Scholar 

  19. Krane V, Heinrich F, Meesmann M, Olschewski M, Lilienthal J, Angermann C, et al. Electrocardiography and outcome in patients with diabetes mellitus on maintenance hemodialysis. Clin J Am Soc Nephrol. 2009;4(2):394–400. https://doi.org/10.2215/CJN.02020408.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Cardoso CRL, Salles GF, Deccache W. QTc interval prolongation is a predictor of future strokes in patients with type 2 diabetes mellitus. Stroke. 2003;34(9):2187–94. https://doi.org/10.1161/01.STR.0000085084.15144.66.

    Article  PubMed  Google Scholar 

  21. • Cox AJ, Azeem A, Yeboah J, Soliman EZ, Aggarwal SR, Bertoni AG, et al. Heart rate-corrected QT interval is an independent predictor of all-cause and cardiovascular mortality in individuals with type 2 diabetes: the diabetes heart study. Diabetes Care. 2014;37(5):1454–61. https://doi.org/10.2337/dc13-1257. There is an association between prolonged QTc and all-cause mortality and CVD mortality in type 2 diabetics.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Pop-Busui R, Evans GW, Gerstein HC, Fonseca V, Fleg JL, Hoogwerf BJ, et al. Effects of cardiac autonomic dysfunction on mortality risk in the action to control cardiovascular risk in diabetes (ACCORD) trial. Diabetes Care. 2010;33(7):1578–84. https://doi.org/10.2337/dc10-0125.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Scheltens T, de Beus MF, Hoes AW, Rutten FH, Numans ME, Mosterd A, et al. The potential yield of ECG screening of hypertensive patients: the Utrecht health project. J Hypertens. 2010;28(7):1527–33. https://doi.org/10.1097/HJH.0b013e328339f95c.

    Article  CAS  PubMed  Google Scholar 

  24. Okin PM, Devereux RB, Nieminen MS, Jern S, Oikarinen L, Viitasalo M, et al. Electrocardiographic strain pattern and prediction of new-onset congestive heart failure in hypertensive patients: the losartan intervention for endpoint reduction in hypertension (LIFE) study. Circulation. 2006;113(1):67–73. https://doi.org/10.1161/CIRCULATIONAHA.105.569491.

    Article  PubMed  Google Scholar 

  25. Satoshi J, Kenei S, Haruyuki T. Impact of electrocardiographic left ventricular hypertrophy on the occurrence of cardiovascular events in elderly hypertensive patients. Circ J. 2010;74:938–45.

    Article  Google Scholar 

  26. • Edison ES, Yano Y, Hoshide S, Kario K. Association of Electrocardiographic Left Ventricular Hypertrophy with Incident Cardiovascular Disease in Japanese older hypertensive patients. Am J Hypertens. 2015;28(4):527–34. https://doi.org/10.1093/ajh/hpu184. Elderly population with hypertension and LVH are associated with a higher risk of cardiovascular events.

    Article  PubMed  Google Scholar 

  27. • Fitzmaurice DA, Mccahon D, Baker J, et al. Is screening for AF worthwhile? Stroke risk in a screened population from the SAFE study. Fam Pract. 2014;31(3):298–302. https://doi.org/10.1093/fampra/cmu011. This randomized cohort study found approximately 37% new cases of atrial fibrillation with a CHADS2 score of one or greater in the elderly population.

    Article  CAS  PubMed  Google Scholar 

  28. • Almahmoud MF, O’Neal WT, Qureshi W, Soliman EZ. Electrocardiographic versus echocardiographic left ventricular hypertrophy in prediction of congestive heart failure in the elderly. Clin Cardiol. 2015;38(6):365–70. https://doi.org/10.1002/clc.22402. This population-based cohort study found that LVH was associated with increased rates of heart failure in the elderly population.

    Article  PubMed  Google Scholar 

  29. • O’neal WT, Almahmoud MF, Qureshi W, Soliman EZ. Electrocardiographic and Echocardiographic Left Ventricular Hypertrophy in the Prediction of Stroke in the Elderly. J Stroke Cerebrovasc Dis. 2015;24(9):1991–7. https://doi.org/10.1016/j.jstrokecerebrovasdis. This population-based cohort study found correlations between LVH and stroke.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Mureddu GF, Tarantini L, Agabiti N, Faggiano P, Masson S, Latini R, et al. Evaluation of different strategies for identifying asymptomatic left ventricular dysfunction and pre-clinical (stage B) heart failure in the elderly. Results from “PREDICTOR”, a population based-study in central Italy. Eur J Heart Fail. 2013;15(10):1102–12. https://doi.org/10.1093/eurjhf/hft098.

    Article  CAS  PubMed  Google Scholar 

  31. Thomas Van Bemmel B, Vinkers DJ, Macfarlane PW, Gussekloo J, Westendorp RGJ. Markers of autonomic tone on a standard ECG are predictive of mortality in old age. Int J Cardiol. 2005;107:36–41. https://doi.org/10.1016/j.ijcard.2005.02.031.

    Article  Google Scholar 

  32. Hodnesdal C, Prestgaard E, Erikssen G, Gjesdal K, Kjeldsen SE, Liestol K, et al. Rapidly upsloping ST-segment on exercise ECG: a marker of reduced coronary heart disease mortality risk. Eur J Prev Cardiol. 2013;20(4):541–8. https://doi.org/10.1177/2047487312444370.

    Article  PubMed  Google Scholar 

  33. Moons KGM, Bots ML, Salonen JT, et al. Prediction of stroke in the general population in Europe (EUROSTROKE): is there a role for fibrinogen and electrocardiography? J Epidemiol Community Heal. 2002;56:30–6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1765507/pdf/v056p00i30.pdf. Accessed December 12, 2017

    Article  Google Scholar 

  34. Khot UN, Khot MB, Bajzer CT, Sapp SK, Ohman EM, Brener SJ, et al. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA. 2003;290(7):898–904. https://doi.org/10.1001/jama.290.7.898.

    Article  PubMed  Google Scholar 

  35. Cushman WC, Grimm RH, Cutler JA, et al. Rationale and Design for the Blood Pressure Intervention of the action to control cardiovascular risk in diabetes (ACCORD) trial. Am J Cardiol. 2007;99(12):S44–55. https://doi.org/10.1016/j.amjcard.2007.03.005.

    Article  Google Scholar 

  36. Rembold C. Number needed to screen: development of a statistic for disease screening. BMJ. 1998;317:307–11. http://www.bmj.com.go.libproxy.wakehealth.edu/content/bmj/317/7154/307.full.pdf. Accessed January 14, 2018.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. EKGs and Exercise Stress Tests | Choosing Wisely. http://www.choosingwisely.org/patient-resources/ekgs-and-exercise-stress-tests/. Accessed January 14, 2018.

  38. Cohen D, Manuel DG, Tugwell P, Sanmartin C, Ramsay T. Direct healthcare costs of acute myocardial infarction in Canada’s elderly across the continuum of care. J Econ Ageing. 2014;3:44–9. https://doi.org/10.1016/J.JEOA.2014.05.002.

    Article  Google Scholar 

  39. Lindholm LH, Ibsen H, Dahlöf B, Devereux RB, Beevers G, de Faire U, et al. Cardiovascular morbidity and mortality in patients with diabetes in the losartan intervention for endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet. 2002;359(9311):1004–10. https://doi.org/10.1016/S0140-6736(02)08090-X.

    Article  CAS  PubMed  Google Scholar 

  40. • O’Neal WT, Mazur M, Bertoni AG, et al. Electrocardiographic predictors of heart failure with reduced versus preserved ejection fraction: the multi-ethnic study of atherosclerosis. J Am Heart Assoc. 2017;6(6):e006023. https://doi.org/10.1161/JAHA.117.006023. Several ECG parameters are consistent with systolic heart failure and other ECG parameters are associated with diastolic heart failure.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to George Waits.

Ethics declarations

Conflict of Interest

Thong Nguyen, George Waits, and Elsayed Z. Soliman declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Novel and Emerging Risk Factors

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nguyen, T., Waits, G. & Soliman, E.Z. The Role of Resting Electrocardiogram in Screening for Primary Prevention of Cardiovascular Diseases in High-Risk Groups. Curr Cardiovasc Risk Rep 12, 9 (2018). https://doi.org/10.1007/s12170-018-0572-y

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s12170-018-0572-y

Keywords

Navigation