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SARA BACHMAN, MS Previous cross-sectional population studies have shown age differences
DAVID SPARROW, MS in electrocardiographic wave patterns, including lower wave amplitudes
L. KENT SMITH, MD and a leflward shift of the frontal plane axis in older people. However,
cross-sectional results may be due to cohort differences and the data
Boston, Massachusetts
imply only that these changes actually occur in persons as they age. In
order to examine electrocardiographic changes with aging in the same
persons, serial recordings, obtained 10 years apart, were taken in 440
healthy male participants of the Normative Aging Study, who were 23 to
66 years old on their first examlnatlon. At examlnatlon 1, I? and S wave
amplitudes were smaller and frontal plane axis measurements were
shifted to the left in older men. Longitudinal changes In these same vari-
ables were consistent with the cross-sectional resufts. In addltlon, the
P-R and Q-T interval durations were longer, the QRS duration was shorter
and the T wave amplitude was smaller at the second examination. The
longitudinal rate of change of S wave amplitude varied among age groups,
decreasing more in younger men. Thus, some prevlously described
cross-sectional age differences truly represent longitudinal age trends
in electrocardiographic patterns.
TABLE II
Cross-Sectional Electrocardiographic Variatlon Among Age Groups: Examlnatlon 1 Data
Cross-sectional results: Examination 1 data were R amplitude (mm) -0.08 0.18 <O.OOl
S amplitude (mm) -0.26 0.36 <O.OOl
examined to determine cross-sectional association of age Frontal plane axis() -0.99 1.93 <O.OOl
with the electrocardiogram (Table II). Subjects were P-R duration (ms) +0.03 0.22 <O.OOl
QFtS duration (ms) -0.04 0.19 <O.OOl
grouped into four age categories for one way analysis of Q-T duration (ms) +0.26 0.37 <O.OOl
variance. Four examination 1 variables differed signif- T amplitude (mm) -0.15 0.26 <O.OOl
icantly among age groups. R and S wave amplitudes
were significantly lower in older people. Frontal plane
axis differed significantly among age groups; values were
lower in older subjects, indicating more left axis devia- certain cross-sectional age differences and longitudinal
tion. The Q-T duration was longer in older age changes in electrocardiographic patterns were observed.
groups. Results indicated that, in older subjects, R and S wave
Longitudinal results: The results of the paired t amplitudes were lower, the frontal plane axis mea-
test, investigating changes in electrocardiographic surement was deviated more to the left and the Q-T
variables between the two examinations, are presented interval duration was longer. All variables changed
in Table III. All variables changed significantly from significantly between the two examinations according
examination 1 to examination 2. Mean R, S and T wave to paired t test results. Results also indicated that the
amplitudes were lower at the second examination than rate of change of S wave amplitude was greater in
at the first. Frontal plane axis moved to the left at the younger than in older subjects, the amplitude decreas-
second examination; P-R and Q-T interval durations ing between examinations in all age groups.
lengthened, and QRS duration was shorter at the second QRS amplitude: In most leads, the R wave is the
examination. largest positive deflection, reflecting the electrical ac-
The null hypothesis that mean annual change rate did tivity of the heart that occurs during ventricular depo-
not differ among age groups was tested using an analysis larization; the S wave signals the end of depolarization.
of variance design (Table IV). The annual rate of change Our longitudinal results of changes in R and S wave
in R and S wave amplitudes varied significantly among amplitudes supported previous findings suggesting that
age groups. Rates of decline in S wave amplitudes were there is less ventricular electrical force in the heart with
greater in younger than in older age groups. No consis- increasing age. 6,g Younger men exhibited greater
tent trend was found for R wave amplitudes. The rate changes than older men in the continual decrease of S
of change of the other variables did not differ signifi- wave amplitude through adulthood.
cantly among age groups. T wave amplitude: Previous cross-sectional stud-
We examined whether the nonsurvivors of the study ies4s5 have indicated lower T wave amplitudes among
population had similar or more electrocardiographic older persons. Similarly, our longitudinal analysis re-
changes initially than the survivors. Our analysis re- vealed a decrease in the T wave amplitude between
vealed that there were only 13 nonsurvivors; approxi- examinations, suggesting a diminution of repolarization
mately half were under age 50 years and half were aged currents with age. These results from serial measure-
50 years or more. No significant differences between ments confirm the inferences made from other cross-
survivors and nonsurvivors were observed for any of the sectional studies that changes in T wave amplitude
electrocardiographic variables. occur with aging.
Electrical axis: Although some leftward shift of the
Discussion frontal plane axis with advancing age is considered
On the basis of data collected from a sample of 440 normal,8 exaggerated shifts may be of clinical impor-
healthy participants of the Normative Aging Study, tance. Leftward shifts of the frontal plane axis to 30 or
TABLE IV
Longitudinal Rate of Electrocardlographlc Change Variation Among Age Groups
more have been associated with heart disease.22 How- gitudinal results showed a lengthening of the Q-T in-
ever, more recent studies of leftward axis movement3 terval duration in older subjects, supporting the results
indicate that such movement is not associated with of Simonson.
heart disease even though it is significantly associated Implications: No longitudinal studies have previ-
with age. The present study suggests that frontal plane ously examined serial electrocardiographic measure-
axis changes occur with age in an apparently normal ments of a broad age range of healthy subjects. Results
population. of our analyses suggest that previously reported cross-
P-R, QRS and Q-T interval durations: Interval sectional electrocardiographic age differences actually
duration measurements are representative of the con- reflect normal longitudinal age trends in some wave
duction time of electrical currents in the heart. The P-R patterns. In addition, we have demonstrated that serial
and QRS interval durations did not vary among our electrocardiographic measurements show changes that
cross-sectional age groups, a finding previously reported occur with age, even in wave patterns that do not vary
by others. 4,6~11~13
However, longitudinally, the P-R du- cross-sectionally. These results identify electrocardio-
ration increased and the QRS duration decreased, graphic changes that can be expected with normal aging
suggesting that there may be true age-related changes in a group of men regarded over time as apparently free
in these measurements. Both cross-sectional and lon- from heart disease.
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