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https://www.arca.fiocruz.br/handle/icict/26873
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ArticleCopyright
Open access
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2020-01-01
Sustainable Development Goals
03 Saúde e Bem-EstarCollections
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VALUE OF THE ELECTROCARDIOGRAPHIC (P WAVE, T WAVE, QRS) AXIS AS A PREDICTOR OF MORTALITY IN 14 YEARS IN A POPULATION WITH A HIGH PREVALENCE OF CHAGAS DISEASE FROM THE BAMBUÍ COHORT STUDY OF AGING
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Universidade Federal de Minas Gerais. Hospital das Clínicas. Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde. Belo Horizonte, MG, Brazil.
Universidade Federal de Minas Gerais. Hospital das Clínicas. Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde. Belo Horizonte, MG, Brazil/Universidade Federal de Minas Gerais. Hospital das Clínicas. Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde. Belo Horizonte, MG, Brazil/Universidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Clínica Médica. Belo Horizonte, MG, Brazil.
Cardiology Department. Children's National Health System. Washington, District of Columbia.
Department of Epidemiology & Prevention. Wake Forest School of Medicine. Winston-Salem, North Carolina.
Fundação Oswaldo Cruz. Instituto de Pesquisas René Rachou. Belo Horizonte, MG, Brazil.
Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Belo Horizonte, MG, Brazil.
Universidade Federal de Minas Gerais. Hospital das Clínicas. Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde. Belo Horizonte, MG, Brazil/Universidade Federal de Minas Gerais. Hospital das Clínicas. Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde. Belo Horizonte, MG, Brazil/Universidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Clínica Médica. Belo Horizonte, MG, Brazil.
Universidade Federal de Minas Gerais. Hospital das Clínicas. Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde. Belo Horizonte, MG, Brazil/Universidade Federal de Minas Gerais. Hospital das Clínicas. Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde. Belo Horizonte, MG, Brazil/Universidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Clínica Médica. Belo Horizonte, MG, Brazil.
Cardiology Department. Children's National Health System. Washington, District of Columbia.
Department of Epidemiology & Prevention. Wake Forest School of Medicine. Winston-Salem, North Carolina.
Fundação Oswaldo Cruz. Instituto de Pesquisas René Rachou. Belo Horizonte, MG, Brazil.
Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Belo Horizonte, MG, Brazil.
Universidade Federal de Minas Gerais. Hospital das Clínicas. Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde. Belo Horizonte, MG, Brazil/Universidade Federal de Minas Gerais. Hospital das Clínicas. Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde. Belo Horizonte, MG, Brazil/Universidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Clínica Médica. Belo Horizonte, MG, Brazil.
Abstract
We sought to investigate the prognostic value of the electrocardiogram (ECG) electrical axes (P wave, T wave and QRS) as predictors of mortality in the 14-year follow-up of the prospective cohort of all residents ≥60 years living in the southeastern Brazilian city of Bambuí, a population with high prevalence of Chagas disease (ChD). Baseline ECG axes were automatically measured with normal values defined as follows: P-wave axis 0° to 75°, QRS axis -30° to 90°, and T axis 15° to 75°. Participants underwent annual follow-up visits and death was verified using death certificates. Cox proportional hazards regression was used to assess the prognostic value of ECG axes for all-cause mortality, after adjustment for potential confounders. From 1,742 qualifying residents, 1,462 were enrolled, of whom 557 (38.1%) had ChD. Mortality rate was 51.9%. In multivariable adjusted models, abnormal P-wave axis was associated with a 48% (hazard ratio [HR] = 1.48 [95% confidence interval (CI) 1.16-1.88]) increased mortality risk in patients with ChD and 43% (HR = 1.43 [CI 1.13-1.81]) in patients without ChD. Abnormal QRS axis was associated with a 34% (HR = 1.34 [CI 1.04-1.73]) increased mortality risk in patients with ChD, but not in individuals without ChD. Similarly, in the ChD group, abnormal T-wave axis was associated with a 35% (HR = 1.35 [CI 1.07-1.71]) increased mortality, but not in patients without ChD. In conclusion, abnormal P-wave, QRS, and T-wave axes were associated with increased all-cause mortality in patients with ChD. Abnormal P-wave axis was associated with mortality also among those without ChD, being the strongest predictor among ECG variables.
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