Prognostic values of clockwise and counterclockwise rotation for cardiovascular mortality in Japanese subjects: a 24-year follow-up of the National Integrated Project for Prospective Observation of Noncommunicable Disease and Its Trends in the Aged, 1980-2004 (NIPPON DATA80).
BACKGROUND
Although clockwise rotation and counterclockwise rotation are distinct findings of the ECG, their prognostic significance is rarely studied.


RESULTS
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. At baseline in 1980, data were collected on study participants aged ≥30 years from randomly selected areas in Japan. We followed 9067 participants (44% men; mean age, 51 years). During the 24-year follow-up, mortality was as follows: 2581 total, 887 CVD, 179 coronary heart disease, 173 heart failure, and 411 stroke. 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 [CI], 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). Counterclockwise rotation was significantly inversely associated stroke in men and women combined (HR=0.77; 95% CI, 0.62-0.96; P=0.017), CVD in men and in men and women combined (HR=0.74; 95% CI, 0.59-0.94; P=0.011 in men; HR=0.81; 95% CI, 0.70-0.94; P=0.006 in combined), and total mortality in women (HR=0.87; 95% CI, 0.77-0.98; P=0.023).


CONCLUSIONS
We found a significant positive association of clockwise rotation and a significant inverse association of counterclockwise rotation with CVD mortality in men and in men and women combined, independent of confounding factors including other ECG changes.
Department of Cardiovascular Epidemiology, Kyoto Women's University, Japan. nakamury@kyoto-wu.ac.jp
Yasuyuki
Y
Nakamura
Tomonori
T
Okamura
Aya
A
Higashiyama
Makoto
M
Watanabe
Aya
A
Kadota
Takayoshi
T
Ohkubo
Katsuyuki
K
Miura
Fumiyoshi
F
Kasagi
Kazunori
K
Kodama
Akira
A
Okayama
Hirotsugu
H
Ueshima
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000401:mortality; D044466:Asian People / Q000706:statistics & numerical data*; D015992:Body Mass Index; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality; D004562:Electrocardiography / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006327:Heart Block / Q000175:diagnosis / Q000401:mortality; D006331:Heart Diseases / Q000175:diagnosis* / Q000401:mortality*; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000401:mortality