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Prognostic value of electrocardiographic abnormalities in adults from the Brazilian longitudinal study of adults’ health
  1. Marcelo Martins Pinto-Filho1,
  2. Luisa Caldeira Brant2,
  3. Rodrigo Padilha dos Reis3,
  4. Luana Giatti4,
  5. Bruce Bartholow Duncan5,
  6. Paulo A Lotufo6,
  7. Maria de Jesus M da Fonseca7,
  8. Jose Geraldo Mill8,
  9. Maria da Conceição Chagas de Almeida9,
  10. Peter MacFarlane10,
  11. Sandhi Maria Barreto11,
  12. Antonio Luiz Pinho Ribeiro2
  1. 1Cardiology, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  2. 2Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
  3. 3Statistics, UFRGS, Porto Alegre, RS, Brazil
  4. 4Medicina Preventiva e Social, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
  5. 5Faculdade de Medicina da UFRGS, Porto Alegre, RS, Brazil
  6. 6Center for Clinical and Epidemiologic Research, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
  7. 7Escola Nacional de Saúde Pública, Fiocruz, Rio de Janeiro, RJ, Brazil
  8. 8Physiological Sciences, Federal University of Espírito Santo, VITÓRIA, ESPÍRITO SANTO, Brazil
  9. 9Fiocruz Bahia, Salvador, BA, Brazil
  10. 10Inst CAMS, University of Glasgow, Glasgow, UK
  11. 11Social and Preventive Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
  1. Correspondence to Professor Antonio Luiz Pinho Ribeiro, Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; tom1963br{at}


Objective Cardiovascular diseases (CVDs) are highly preventable non-communicable diseases. ECG is a potential tool for risk stratification with respect to CVD. Our aim was to evaluate ECG’s role in all-cause and cardiovascular mortality prediction.

Methods Participants from the Brazilian Longitudinal Study of Adult Health, free of known CVD at baseline were included. A 12-lead ECG was obtained at baseline (2008–2010). Participants were followed up to 2018 by annual interviews. Deaths were independently reviewed. Cox as well as Fine and Grey multivariable regression models were applied to evaluate if the presence of any major electrocardiographic abnormality (MEA), defined according to the Minnesota Code system, would predict total and cardiovascular deaths. We also evaluated the Net Reclassification Index of adding MEA to the Systematic Coronary Risk Evaluation (SCORE).

Results The 13 428 participants (median age 51 years, 45% men) were followed up for 8±1 years. All-cause and cardiovascular mortality occurred in 2.8% and 1.2% of the population, respectively. Prevalent MEA was an independent predictor of overall (HR=2.3, 95% CI 1.7 to 2.9) and cardiovascular mortality (HR=4.6, 95% CI 3.0 to 7.0) after adjustments for age, race, education and traditional cardiovascular risk factors. Adding MEA to the SCORE resulted in 9% mis-reclassification in the non-event subgroup and 33% correct reclassification in those with a fatal cardiovascular event.

Conclusion Presence of MEA was an independent predictor of overall and cardiovascular mortality. ECG may have a role in risk prediction of cardiovascular mortality in primary care.

  • ECG/electrocardiogram
  • cardiac risk factors and prevention
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  • Contributors MMP-F, LCB and ALPR contributed to the conception or design of the work. SMB, LG, BBD, PAL, MdJMdF, MdCCdA and JGM contributed to the acquisition of dat. MMP-F, LCB, RPdR and ALPR to the analysis or interpretation of data for the work. MMP-F, LCB, SMB and ALPR drafted the manuscript and all critically revised the manuscript. All gave the final approval and agreed to be accountable for all aspects of the work ensuring integrity and accuracy.

  • Funding The ELSA‐Brasil baseline study was supported by the Brazilian Ministries of Health and of Science and Technology (grants 01060010.00RS, 01060212.00BA, 01060300.00ES, 01060278.00MG MG, 01060115.00SP and 01060071.00RJ). PAL, SMB, LG and ALPR are supported by a research grant from CNPq. ALPR is also supported by a research grant (Pesquisador Mineiro) from FAPEMIG, the research agency of the State of Minas Gerais, Brazil.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by local ethics committees of the six participating institutions and complies with the Declaration of Helsinki (Comitê de Ética em Pesquisa da UFMG Approval ETIC 186/6).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All relevant data were included. All data are available.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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