The Female Electrocardiogram: Special Repolarization Features, Gender Differences, and the Risk of Adverse Cardiac Events

150 Pages·2015·4 MB·English

by  Pentti M. Rautaharju (auth.)

Pentti M. Rautaharju
The Female
Electrocardiogram
Special Repolarization
Features, Gender Diff erences,
and the Risk of Adverse
Cardiac Events
123
The Female Electrocardiogram

Pentti M. Rautaharju
The Female
Electrocardiogram
Special Repolarization Features,
Gender Differences, and the Risk
of Adverse Cardiac Events
Pentti M. Rautaharju
Division of Public Health Sciences
Wake Forest School of Medicine
Winston-Salem , NC
USA
ISBN 978-3-319-15292-9 ISBN 978-3-319-15293-6 (eBook)
DOI 10.1007/978-3-319-15293-6
Library of Congress Control Number: 2015934580
Springer Cham Heidelberg New York Dordrecht London
© Springer International Publishing Switzerland 2015
T his work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
T he use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
T he publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made.
Printed on acid-free paper
Springer International Publishing AG Switzerland is part of Springer Science+Business Media
(www.springer.com)
Dedicated to my wife Dr. Farida Rautaharju,
who collaborated with me for over a quarter
of a century in operating EPICARE, a core
ECG center for epidemiological studies and
clinical trials.

Pref ace
Happy Hearts and Broken Hearts
I n many industrialized countries including the USA, cardiovascular disease (CVD)
continues to be the leading cause of death. Early epidemiological and clinical stud-
ies on coronary heart disease (CHD) focused almost exclusively on men. CHD was
considered to be a male disease, and women's health issues had a low priority.
Political pressure gradually changed the situation, and as a result, major research
programs addressing women's health issues were introduced, such as the large-scale
Women's Health Initiative (WHI) study in 1991. Since then, women have been
increasingly included in CHD intervention efforts, but substantial gender differ-
ences still remain in CVD prevalence and mortality. The number of heart attacks or
fatal CHD annually in women equals that in men but with a shift in time by 10 years.
Differences in population demographics account for the fact that in terms of abso-
lute numbers, more women than men are living with and dying from CHD, and
more women than men are discharged from hospitals with diagnosis of heart failure
and stroke.
E lectrocardiography plays an important role in prevention of CHD and in pre-
vention of adverse cardiac events associated with CHD. New ECG predictors for
CHD morbidity and mortality have recently emerged. The goal of this monograph
is to examine closer these new promising predictors. The primary objective is to
evaluate gender differences in special ECG features and in ECG predictors for the
risk of adverse cardiac events and to explore mechanisms for gender differences in
risk predictors.
The noble mission of medicine is to alleviate pain and preferably to prevent the
disease causing the suffering. Among the challenging missions of cardiovascular
medicine is to prevent CHD and CVD. Improved knowledge of gender differences
and special features in female electrocardiogram will help in this task. Substantial
progress has been made in improving therapeutic actions to treat patients in condi-
tions such as acute coronary syndrome (ACS) and heart attack caused by CHD. CHD
preventive efforts are also gradually, albeit slowly, bringing tangible results. Genetic,
vii
viii Preface
neurohormonal, and environmental factors involved in CHD, CVD, and SCD are
complex, as is life itself. Well-balanced harmony of these factors makes a happy
heart, and at the other extreme, death from a broken heart has been documented to
occur in prolonged excessive sympathetic overdrive in uncontrolled grief.
Weston, FL, USA Pentti M. Rautaharju
Acknowledgement
I wish to acknowledge the collaboration of the present and former staff members
and directors of the EPICARE Center, particularly Dr. Zhu-ming Zhang, Dr. Ronald
J. Prineas, and Dr. Elsayed Soliman. The EPICARE Center, initially at Dalhousie
University and the University of Alberta, Canada, and since 1994 at Wake Forest
University School of Medicine, NC, has been in charge of ECG analysis for all
major national health surveys of the National Center for Health Statistics and United
States Centers for Disease Control and Prevention and for many collaborative clini-
cal trials sponsored by NIH, such as the Multiple Risk Factor Intervention Trial
(MRFIT), the Women's Health Initiative (WHI), Cardiovascular Health Study
(CHS), and the Arteriosclerosis Risk in Communities (ARIC) study.
I also wish to express my appreciation and gratitude to Dr. Henry Blackburn, my
friend and collaborator during the formative and formidable years of my graduate
studies at the University of Minnesota in the early 1960s, when the foundations of
epidemiological electrocardiography were laid. It is worth noting that according to
the citation index, the Minnesota code paper (Blackburn H et al. C irculation .
1960;21:1160–75) was still in 2012 among the four most frequently cited articles in
electrocardiographic literature.
ix