Maturitas 67 (2010) 159–165 Contents lists available at ScienceDirect Maturitas journal homepage: www.elsevier.com/locate/maturitas Electrocardiographic abnormalities of left ventricular repolarization: Prognostic implications in hypertensive post-menopausal women Fabio Angeli a,∗ , Enrica Angeli b , Claudio Cavallini a , Giuseppe Ambrosio c , Giovanni Mazzotta a , Gianpaolo Reboldi d , Paolo Verdecchia e a Department of Cardiology and Clinical Research Unit, Preventive Cardiology, Hospital ‘S. Maria della Misericordia’, 06100 Perugia, Italy b Department of Obstetrics and Gynecology, Hospital San Giovanni Battista, Foligno, Italy c Department of Cardiovascular Pathophysiology, University of Perugia, Italy d Department of Internal Medicine, University of Perugia, Italy e Department of Medicine, Hospital of Assisi, Italy article info Article history: Received 20 February 2010 Received in revised form 7 May 2010 Accepted 8 June 2010 Keywords: Hypertension Arterial Menopause Prognosis ECG Epidemiology abstract Background: Although repolarization abnormalities on ECG are frequent in post-menopausal hypertensive women, their prognostic value in these women is uncertain. Methods: We analyzed 908 hypertensive post-menopausal women consecutively included in the PIUMA (Progetto Ipertensione Umbria Monitoraggio Ambulatoriale) study. The median duration of follow-up was 8.6 years (range: 1–21). All women were untreated at entry. Drug treatment during follow-up was adjusted to single individuals. Standard 12-lead ECG was carried out at entry. The Minnesota Coding was used to define minor and major (“typical strain”) repolarization abnormalities. Design: prospective observational study in essential hypertension. Results: Mean age at entry was 60 years. At baseline, ECG was normal in 707 women, minor ST-T changes were noted in 152 women, and a typical strain pattern was present in 49 subjects. Predictors of typical strain were age, diabetes and systolic blood pressure (BP). During follow-up there were 119 new cardio- vascular (CV) events and 75 all-cause deaths. Typical strain was associated with a threefold higher risk of CV disease (HR: 3.16; 95% CI: 1.59–6.31; p = 0.001) after adjustment for the significant influence of age, diabetes, serum creatinine, systolic BP and HDL-cholesterol. Women with minor LV repolarization abnormalities showed a non-significant excess risk of CV disease when compared with women with nor- mal LV repolarization (HR: 1.25; 95% CI: 0.69–2.26; p = 0.467). Similar results were obtained for all-cause mortality. Conclusions: Typical strain pattern, an easily detectable marker of altered LV repolarization, identifies post-menopausal hypertensive women at increased risk of CV disease and all-cause mortality. © 2010 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Left ventricular (LV) repolarization abnormalities, detected by electrocardiography (ECG), are frequently detected in women [1,2]. Although it is well established that the prevalence of these ECG abnormalities increases with age [1,2], considerable uncertainty surrounds the issue of their prognostic value. In the general population, these abnormalities did not show any significant pre- Abbreviations: LV, left ventricular; ECG, electrocardiography; CV, cardiovascu- lar; BP, blood pressure; ACE, angiotensin converting enzyme; AT-II, angiotensin II; CHD, coronary heart disease; MI, myocardial infarction; SD, standard deviation; CI, confidence interval; HR, hazard ratio. ∗ Corresponding author. Tel.: +39 075 5782213; fax: +39 075 5782214. E-mail address: fangeli@cardionet.it (F. Angeli). dictive effect on outcome [1,3–6]. In contrast, in hypertensive [7] or healthy post-menopausal women [8,9], ST-T changes on ECG were associated with a significantly increased risk for future cardiovascular (CV) disease. The prevalence of LV repolarization abnormalities is about 30% in untreated hypertensive patients and this value increases with the severity of hypertension [10]. Although hypertension is the most important risk factor for CV disease after menopause [11], the prognostic impact of repolar- ization abnormalities has never been specifically investigated in hypertensive post-menopausal women. In particular, two clini- cally relevant aspects remain unknown: (1) whether the major and minor abnormalities of LV repolarization are associated with a different risk prediction; (2) whether the prognostic informa- tion provided by LV repolarization is independent from that of several potentially associated confounders including the sever- ity of hypertension and age. Thus, the aim of our study was to 0378-5122/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.maturitas.2010.06.009