The aim of the present study was to assess the independent prognostic values of clockwise rotation and counterclockwise rotation for mortality due to CVD and its subtypes in a large cohort of participants obtained from randomly selected health districts in Japan. Although clockwise rotation and counterclockwise rotation are distinct findings of ECG, their clinical values have not been well studied, and their prognostic significance has been studied only rarely. The transitional zone is related to the direction of the QRS axis in the horizontal plane. 10 The other ECG changes that have been shown to have prognostic significance are Q-wave abnormalities, ST-T abnormalities with or without high left R waves, prolonged QRS duration, and atrial fibrillation (AF). 8 Publication of studies on prognostic values of ECG changes arrived in the1960s, when LVH by ECG was found to show an increase in cardiovascular disease (CVD) mortality in hospital-based patients, 9 as well as in general populations. Since the first report by Einthoven 1 of accurate recording of the ECG and its development as a clinical tool in 1895, the early phase of ECG studies was devoted to descriptions of ECG changes in disease conditions, such as arrhythmia, 2 – 5 angina pectoris, 6 and myocardial infarction, 7 or to formation of diagnostic criteria from comparative evaluations between ECG findings and anatomic changes, such as left ventricular hypertrophy (LVH). The multivariate-adjusted hazard ratio (HR) with the use of the Cox model including biochemical and other ECG variables revealed that clockwise rotation was significantly positively associated with heart failure in men and women combined (HR=1.79 95% confidence interval, 1.13–2.83 P=0.013), CVD in men and in men and women combined (HR=1.49 95% CI, 1.12–1.98 P=0.007 in men HR=1.28 95% CI, 1.02–1.59 P=0.030 in combined), and total mortality in men and in men and women combined (HR=1.19 95% CI, 1.00–1.49 P=0.0496 in men HR=1.15 95% CI, 1.00–1.32 P=0.045 in combined).
During the 24-year follow-up, mortality was as follows: 2581 total, 887 CVD, 179 coronary heart disease, 173 heart failure, and 411 stroke. We followed 9067 participants (44% men mean age, 51 years). At baseline in 1980, data were collected on study participants aged ≥30 years from randomly selected areas in Japan. We studied prognostic values of clockwise and counterclockwise rotation on total, cardiovascular disease (CVD), and subtype mortality using the National Integrated Project for Prospective Observation of Noncommunicable Disease and Its Trends in the Aged, 1980–2004 (NIPPON DATA80) database with a 24-year follow-up. Customer Service and Ordering Information.Stroke: Vascular and Interventional Neurology.
Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).
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