Background: We previously reported that electrocardiographic (ECG) clockwise rotation (CWR) was positively and counter-clockwise rotation (CCWR) was inversely associated with cardiovascular disease (CVD) mortality in Japanese using 24 Year Follow-up of NIPPON DATA80. Re-evaluation of the prognostic values of CWR and CCWR in a different cohort is needed.
Methods: We studied prognostic values of CWR and CCWR on total and CVD mortality using the NIPPON DATA90 database with a 20-year follow-up. At the baseline in 1990, data were collected on study participants, ages 30 years and over, from randomly selected areas in Japan. We followed 8,262 participants without major ECG abnormalities, or history of stroke or myocardial infarction (41.8% men, mean age 53.0 y) for 20 years. Analysis was made in men and women combined.
Results: Among participants, 49.9% were in the normal rotation group, 7.2% in CWR group, and 42.9% in CCWR group. During the 20 year follow-up, there were 1,997 total, and 605 CVD mortality. The multivariate-adjusted hazard ratio (HR) using the Cox model including age, sex, BMI, alcohol and smoking status, hypertension, diabetes and other ECG variables revealed that CWR was significantly positively associated with total mortality (HR=1.19, 95% confidence intervals [CI]: 1.02-1.39, P=0.032), but not with CVD mortality (HR=0.99 [0.68-1.33], P=0.95). CCWR was significantly inversely associated with CVD (HR=0.81 [0.68-0.96], P=0.016), and total mortality (HR=0.91 [0.83-0.997], P=0.043).
Conclusions: We have reconfirmed a significant positive association of CWR in total mortality, and a significant inverse association of CCWR with CVD and total mortality in men and women combined, independent of confounding factors including other ECG changes.