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= Abs t r ac t = E le ctroc ardiog raphic F indin g s of a Com m unity P e ople by Com puterize d D ev ic e for A n aly s is E s u n K o o, Jae - Y ou n g K im, H a e - Joon K im D epartm ent of Prev entiv e M edicine and In s titute for Env ironm ental He alth, Colleg e of Medicine, Korea U niv ersity In order t o determ ine the prev alence r at e an d fin d out th e sex ual difference of abnorm al electrocardiographic finding s m anifested by computerized EKG, w hich is equipped w ith auto- analy zin g function, a total of 2,083 electrocardiogram s that w ere taken from population ov er 20 y ear s - old from Octob er 1996 to F ebru ary 1997 w ere studied accordin g to th eir age, g ender and blood pres sure. 1. U sing th e electrocardiography w ith auto- an aly zing function, 33 kinds of abnorm al fin ding s w ere m anifested. T he prev alence rate of abnorm al findin g s w as 52.8% in male and 43.7% in fem ale. Am ong them, the m ost comm on fin din g w as sinu s brady cardia foun d in 17.6% of male an d 15.4% of fem ale. Left v entricular hypertrophy by v oltag e criteria, minim al v olt ag e of left v entricular hypertr ophy, left ax is deviation and atrial fibrillation w er e m or e common in m ale th an in fem ale statistically. Both of n ospecific T w av e an d ST segm ent abn orm ality w ere m ore comm on in fem ale than in male statistically. 2. T hirty - three kin ds of abn orm al findin g s w ere m anifested. T hey rev ealed one abnormal fin ding alone or combined w ith som e other on es m aking 128 kinds of abnormal findin g s. T he m ost comm on abn orm al finidin g th at m anifested alon e w as right ax is deviation (100% ), th en my ocardial isch emia (95.7% ) th e nex t. T h e m ost common abnormal fin ding that complex ed w ith other abn orm al finding s w er e left anterior fascicular block (per cent age of sin gle m anifestation ; 26.2% ) and non specific T w av e abnorm ality (percentage of single m anifestation ; 32.9% ). Also, combin ation of sinu s brady cardia an d minim al v oltage of left v entricular hypertr ophy, and com bination of sinu s brady cardia an d left v entricular hypertr ophy w er e included in 25th sequences of abnorm al findings. 3. T he prev alence rate of abnorm al electrocardiographic findin g s w ere high er in older group,

hyperten siv e group, and th e group of high er sy stolic or diastolic pressure in both sex es. 4. Abn orm al finding s that commonly m anifested w ith sinu s brady cardia w ere v oltage criteria or minim al v oltage of left v entricular hypertr ophy (38.6% ); sinu s arrhythm ia (10.5% ); n on specific T w av e or ST segm ent abn orm ality (18.4% ) and fir st degree AV block (7.2% ) in descendin g order. 5. T h e m ost comm on site w hich m anifested my ocardial ischemia w as posterior an d inferior w all w ith equal percentage of 23.4%. An d then anterior w all(19.1% ), an d antero- lateral w all an d septum w ith equ al percentag e of 10.6% w as noted in descendin g order. Key W ords : prev alen ce rate, abnorm al electrocardiographic fin din g, computerized device for an aly sis, electr ocardiography of com munity

I...,,,,,...,,.,.... II. 1. 20 11,599 2,509 (21.6% ).,. 2.. 1996 10 1997 2

3.,,,,,,,,,. 4.,,, 3. M arquette Electronic MA C 6. 5. (standard limb lead ) Lead I, II, III (au gm ented unipolar limb lead ) avr, avl, avf, (precordial lead) V 1, V 2, V3, V4, V5, V6 12.. 5.. 6.,,,, 2 test, SA S v er sion 6.12. III. 1. 20 11,599 2,509 21.6%, 425 2,083. 18.0%, 83.0%. 10 20-29 1.8%, 60-69 53.0%. (T able 1).

T able 1. Participation rate to E KG test am ong total population by sex and ag e A ge N o. of T arg et Population M ale No. of E KG Analy zed % No. of T arget Population F em ale N o. of EKG An aly zed 20-29 1,998 36 1.8 1,396 47 3.4 30-39 1,324 81 6.1 1,110 173 15.6 40-49 1,011 103 10.2 958 191 20.0 50-59 858 168 19.6 914 333 36.4 60-69 492 201 40.9 693 367 53.0 70< = 277 132 47.7 572 251 43.9 T otal 5,956 721 12.1 5,643 1,362 24.1 % 2. 10, (T able 2). T able 2. Sex subject s A g e Group an d age diatribution of EKG an aly zed M ale (n =721) F em ale (n =1,362) No. % No % 20-29 36 5.0 47 3.5 30-39 81 11.2 173 12.7 40-49 103 14.3 191 14.0 50-59 168 23.3 333 24.4 60-69 201 27.9 367 26.9 70< = 132 18.3 251 18.4 2 4.056 p v alue 0.541 3. 33.,. T able 3, 33. (left v entricular hypertrophy by v oltag e criteria ), 1, 1 1.,.

(sinu s brady cardia ) 17.6%, 15.4%. 2% 9,, v oltage criteria (12.2% ), (9.2% ), (4.4% ), 1 (2.9% ), (2.6% ), T (2.5% ), (2.4% ) (2.2% ). 2% 10,, (7.3% ), T (7.0% ), (5.7% ), ST (4.0% ), (3.3% ), 1 (3.2% ), (2.6% ), (2.3% ), (2.0% ).. 3 (7.0% ) T 7 (2.5% ), 5 (4.0% ) ST 11 (1.8% ). 12 (1.4% ) occasional premature v entricular complex 19 (0.7% ), 18 (0.7% ) 10 (1.9% ). 6, (p =0.001), (p =0.003), (p =0.014), (p =0.019), T (p =0.001) ST (p =0.008). (p =0.186).

T able 3. T he prev alence rate an d sequen ce of abn orm al findin g s accordin g to sex Abnorm al EKG Findin g s M ale (n =721) F em ale (n =1,362) p * No % Seq. * * No % Seq. * * Sinus Bradycardia 128 17.6 1st 210 15.4 1st 0.169 LVH # by Voltage Crit eria 88 12.2 2n d 99 7.3 2nd 0.001 Minim al Voltage of LVH # 66 9.2 3rd 78 5.7 4th 0.003 Moderate Volt age of LVH # 32 4.4 4th 45 3.3 6th 0.192 Fir st Degree AV Block 21 2.9 5th 43 3.2 7th 0.875 Sinus Arrhythmia 19 2.6 6th 31 2.3 9th 0.610 Nonspecific T W ave Abnormality 18 2.5 7th 95 7.0 3r d 0.001 Right Bundle Branch Block 17 2.4 8th 27 2.0 10th 0.571 Rightw ard Axis 16 2.2 9th 19 1.4 12th 0.164 Left Axis Deviation 14 1.9 10th 10 0.7 18th 0.014 Nonspecific ST Segment Abnormality 13 1.8 11th 54 4.0 5th 0.008 Incomplet e RBBB 13 1.8 11th 20 1.5 11th 0.561 Myocardial Ischemia 12 1.7 13th 35 2.6 8th 0.186 Left Atrial Enlar gement 11 1.5 14th 16 1.2 14th 0.501 Sinus T achycar dia 11 1.5 14th 12 0.9 16th 0.180 Left Anterior Fascicular Block 11 1.5 14th 12 0.9 16th 0.180 Atrial Fibrillation 10 1.4 17th 6 0.4 19th 0.019 Occasional Premature Supraventricular Complex 6 0.8 18th 16 1.2 14th 0.467 Occasional Premature Ventricular Complex 5 0.7 19th 19 1.4 12th 0.145 Right Axis Deviation 4 0.6 20th 6 0.4 19th 0.720 Occasional Premature Atrial Complex 4 0.6 20th 3 0.2 0.209 Occasional Premature Ectopic Complex 2 0.3 6 0.4 19th 0.567 Second Degree AV Block 2 0.3 3 0.2 Frequent Pr emature Vent. Complex 0 0.0 4 0.3 Left Bundle Branch Block 0 0.0 4 0.3 Left Posterior Fascicular Block 1 0.1 2 0.2 Ectopic Atrial Rhythm 2 0.3 1 0.0 Wolff- Parkinson- White Syndrome 3 0.4 0 0.0 Junctional ST Depression 0 0.0 2 0.1 Right Ventricular Hypertrophy 1 0.1 0 0.0 Left Atrial Rhythm 0 0.0 1 0.0 Right Superior Axis Deviation 0 0.0 1 0.0 Prolonged QT Int erval 1 0.1 0 0.0 Bilateral Bundle Br anch Block 1 0.0 0 0.0 * p v alue by 2 test ** Sequence # LVH : left ventricular hypertrophy

4.. (sinu s ),,, (ax is ),, 6 (T able 4). 21.9%, 18.6% (p =0.111). 2 8.2% 7.3% (p =0.492). 2 11.1% 4.4% (p =0.001). 4 6. 5. T able 4. T he prev alence rate of grouped abnormal fin ding s according to sex Group M ale (n =721) F em ale (n =1,362) p * N o % Rank No % Rank Sinu s Related Abn orm al F in ding s ( 1 ) 158 21.9 1st 253 18.6 1st 0.111 Condu ction related Abn orm al F in ding s (2 ) 59 8.2 2nd 100 7.3 3rd 0.492 Abnorm ality on Ax is (3 ) 34 4.7 3rd 36 2.6 5th 0.013 Abnorm al W av es (4 ) 32 4.4 4th 151 11.1 2nd 0.001 Atrium Related A bnormal Findin g s (5 ) 23 3.2 5th 23 1.7 6th 0.027 Prem ature Complex es (6 ) 17 2.4 6th 48 3.5 4th 0.145 * p value by 2 test (1) Sinus Bradycardia, Sinus Arrhythmia, Sinus T achycardia (2) 1st Degree AV Block, 2nd Degree AV Block, Left Bundle Branch Block, Right Bundle Branch Block, Bilateral Bundle Branch Block, Incomplete RBBB, Left Anterior F ascicular Block, Left Posterior F ascicular Block, W olff- Parkinson - White Syndrome (3) Left Axis Deviation, Rightw ard Axis, Right Axis Deviation, Right Superior Axis Deviation (4) Nonspecific T Wave Abnorm ality, Nonspecific ST Segment Abnorm ality, Junctional ST Depression, Prolonged QT Interval (5) Atrial Fibrillation, Left Atrial Rhythm, Left Atrial Enlargement, Ectopic Atrial Rhythm (6) Occasional Prem ature Vent. Complex, Occasional Premature Supraventriclar Complex, Occasional Prem ature Ectopic Complex, Occasional Premature Atrial Complex, Frequent Prem ature Vent. Complex 5. 33 128. 25 T able 5.. 338. 185, 153 54.7%.

(100.0% ), (95.7% ), (76.6% ), (75.7% ), occasion al prem ature v entricular complex (70.9% ), (70.8% ). (40.7% ), ST (32.9% ), left anterior fascicular block (26.1% ). 25 (26 ; 13 ), (22 ; 18 ). 25 7 6. T able 5. T h e frequency of sin gle or combin ed m anifestation of comm on abnormal EKG finding s Sequ en ce Abn orm al Fin din g T otal Sin gle Comb - in ed Sin gle/ T otal (% ) 1st Sinu s Brady cardia 338 185 153 54.7 2nd V oltage Crit eria of Left Ventricular Hypertr ophy 187 94 93 50.3 3rd M inim al V oltag e of Left V entricular Hypertr ophy 144 109 35 75.7 4th Non specific T w ave abnorm ality 113 57 56 50.4 5th M oderate V oltage of Left V entricular Hypertr ophy 77 59 18 76.6 6th N on specific ST Segm ent Abn orm ality 67 22 45 32.9 7th F ir st Degree AV Block 64 29 35 45.3 8th Sinu s Arrhythm ia 50 27 23 54.0 9th My ocardial Ischemia 47 45 2 95.7 10th Right Bun dle Br an ch Block 44 24 20 54.5 11th Rightw ard Ax is Deviation 35 35 0 100.0 12th In complete Right Bundle Branch Block 33 16 17 48.8 13th Left A trial Enlar g em ent 27 11 16 40.7 14th Sinu s Brady cardia & Minimal Voltag e of LVH 26 (26) 15th Left A xis Deviation 24 17 7 70.8 15th Occasion al Prem ature V entricular Complex 24 17 7 70.9 17th Left A nt erior F ascicular Block 23 6 17 26.1 17th Sinu s T achy cardia 23 12 11 52.2 19th Sinu s Brady cardia & LVH 22 (22) 19th Occasion al Prem ature Suprav entricular Complex 22 14 8 63.6 20th Atrial F ibrillation 16 9 7 56.3 21th Non specific T W ave Abnorm ality & N on specific ST Segm ent Abn orm olity 14 (14) 22th Sinu s Brady cardia & Sinu s Arrhythmia 12 (12) 23th Sinu s Brady cardia & M oderate V oltag e LVH 11 (11) 24th Sinu s Brady cardia & Rightw ard Ax is 10 (10) 25th Right A xis Deviation 10 9 1 90.0

6.,, T able 6, 7, 8, 9,,. 50, 70 10 4,. 20-49. 50 50 50-59 60-69. 70.(T able 6). T able 6. T he prev alence rate abn orm al findin g s according to sex and ag e A g e Group M ale (n =721) F em ale (n =1,362) Abnorm al Norm al Abnorm al N orm al 20-49 85 135 116 295 38.6 61.4 28.2 71.8 50-59 100 68 159 174 59.5 40.5 47.8 52.3 60-69 119 82 175 193 59.2 40.8 47.6 52.5 70< = 77 58.3 55 41.7 145 58.0 2 25.688 65.234 p v alue 0.001 0.001 105 42.0 140 H g 90 H g, 140 H g 90 H g 95 H g 90 Hg 140 H g 160 H g, 160 H g 95 Hg (T able 7).,. 10.7%. 12.8% 10.7% 12.7% 17.0% (T able 7).

T able 7. T h e prev alence rate of abn orm al fin din g s according to sex and blood pres sure M ale F emale Group of (n =721) (n =1,362) Blood Pres sure Abnorm al N orm al Abn orm al Norm al N orm oten sion 211 217 353 561 49.3 50.7 38.6 61.4 Borderlin e Hyperten sion 57 51.4 54 48.7 82 51.3 78 48.8 Definite Hyperten sion 113 62.1 69 37.9 160 55.6 2 8.499 29.744 p v alue 0.014 0.001 128 44.4 120 H g, 180 Hg, 120 H g 180 H g 20 H g,. 120 H g 26.1%. 120 Hg (T able 8). T able 8. T h e prev alen ce rate of abn orm al finding s according to sex and sy stolic blood pressure Sy stolic Pres sure M ale (n =721) F em ale (n =1,362) ( H g ) Abn orm al N orm al Abnorm al Norm al < 120 42 22 104 159 65.6 34.4 39.5 60.5 120-139 180 208 266 424 46.4 53.6 38.6 61.5 140-159 102 83 131 124 55.1 44.9 51.4 48.6 160-179 25 15 48 31 62.5 37.5 60.8 39.2 180< = 32 72.7 12 27.3 46 61.3 2 19.545 34.210 p v alue 0.001 0.001 29 38.7 85 H g, 115 H g, 10 H g 5,. 115 Hg 15.0% (T able 9).

T able 9. T h e prev alence rate of abn orm al fin ding s according to sex and diastolic blood pressure Diastolic Pressure M ale (n =721) F em ale (n =1,362) ( H g ) Abnorm al N orm al Abn orm al N orm al < 85 167 159 286 422 51.2 48.8 40.4 59.6 85-95 118 117 168 231 50.2 49.8 42.1 57.9 95-105 63 42 87 74 60.0 40.0 54.0 46.0 105-115 25 15 30 28 62.5 37.5 51.7 48.3 115< = 8 53.3 7 46.7 24 66.7 2 4.651 19.785 p v alue 0.325 0.001 12 33.3,,.. 7. 338, 185 153,. 20.3%, 18.3%, 10.5%, 15 (T able 10).

T able 10. T he frequen cy of combin ed abnorm al finding s w ith sinu s brady cardia Sequen ce Combined Abn orm al F in ding w ith Sinu s Brady cardia N o % 1st Left Ventricular Hypertr ophy by V oltage Crit eria 31 20.3 2nd M inim al V oltage of Left V entricular Hypertr ophy 28 18.3 3rd Sinu s Arrhythmia 16 10.5 4th Non specific T W ave Abnorm ality 14 9.2 4th N on specific ST Segm ent Abnorm ality 14 9.2 6th F ir st Degree AV Block 11 7.2 6th M oderate V oltage of Left V entricular Hypertrophy 11 7.2 8th Rightw ard Ax is Div iation 10 6.5 9th Right Bun dle Br an ch Block 8 5.2 10th Left Axis Dev iation 3 2.0 11th Left Ant erior F ascicular Block 2 1.3 11th Occasion al Premature Suprav entricular Complex 2 1.3 13th In complete Bundle Branch Block 1 0.7 13th Left Atrial Enlargem ent 1 0.7 13th Occasion al Premature Atrial Complex 1 0.7 T otal 153 100.0 8. 9 47 T able 11. (posterior ) (inferior ) 11 (23.4% ), (anterior ) 9 (19.1% ), (antero- lateral) (septal) 5 (10.6% ). T able 11. T he frequen cy of my ocardial ischemia by site Sequ en ce Site No % 1st Posterior 11 23.4 1st Inferior 11 23.4 3rd Anterior 9 19.1 4th Antero- lateral 5 10.6 4th Septal 5 10.6 5th Lateral 2 4.3 5th My ocardial Infarction 2 4.3 5th A cute My ocardial Infarction 2 4.3 T otal 47 100.0

IV.,, 18%,.. T able 2.. 25.2%, 21.1%, 15.4%, 11.7%. Kim (1981) 14.0%, 9.8% NHA NESII(1976-1980) 18 17.4%, 18.0%.,., 60 46.2%, 45.4%.,,. (1984) (1996). 1 52.8%, 43.7%. (1984) 49%, 47%.. (1996) 6.5%, 5.7%,, (w ithin norm al limit ).,, 21.9%, 18.6%. 60,, (Hu ston, 1985; Ordw ay, 1982). 17.6%, 15.4%. Hiss (1962) 122,143 23.8%, (1984) 3.0% 1.4% (1971) 2.4%, 1.4%.. 50% (Coh en, 1980; Gan se, 1970),,, (, 1991;, 1992a ;, 1992b ) 25.0% 45.5% 33.0% 60,0%. 100. 1.5%, 0.9%. Hiss (1961) 0.31% ( ) (1984)

7.1%, 7.9%. (1984) 30 30 5.0%, 2.3% (1984) 30 22.0% 38.5%.. 7,104 (1971) 10.9%, 13.6%,. (1971). 2.6%, 2.3%. His s (1962) 2.3% ( ), (1984) 2.5%, 2.0%. (1971) 8.1%, 7.6%.. (, 1991). 3, left v entricular hypertrophy by v oltag e criteria, m oderate v oltag e of LVH, minimal v oltag e of LVH.,,. 12.2%, 7.3%. Hiss (1962) 3.9% ( ) (1984) 4.8%, 2.5%. (1971) 18.9%, 10.3%.,. Cohen (1980) Smith (1964) 14-85% (1992b ) 33.3%, 58.3%. (1983) 325 70.5%. Hiss (1962) (1983), 60. T 2.5%, 7.0%. Hiss (1962) 1.15%, 5.4%, 8.0% (1984). (1971) 17.1% 19.9%. Ostran der (1965). ST 1.8%, 4.0%. (1984) 2.0%, 2.2%. 30 ST (, 1984). (1971) ST 22.1%, 20.9% ST

2.9%, 0.5%. Ostrander (1965). 8.2%, 7.3%. (1996), 2.8%, 1.6%. 1, 2,,,. 1 2.9%, 3.2%. Hiss (1962) 0.65% (1984) 1.6%, 0.9%. (1984), 50 2.7%, 1.9%. (1984) 50 32.9%, 30.5% 69.5% (T abel 2).. M eytes (1975), Smith (1964), North cote (1989) 10-33%,. 2.4%, 2.0%. Hiss (1962) 0.18% ( ) (1984) 1.4%, 0.9%, (1971) 1.6%., 50 (1984). (1984). 1.8%, 1.5%. (1971) 0.9%, (1984) 4.3%, 1.8%. (1984) 40... 4, 0.0%, 0.3%. (1971) 0.2% (1984) 0.2%, 0.2%. Hiss (1961) 0.013% ( ). 1.2%. (1971) 4.7% (1968) 3.48%.. 1 1.2%. (1971) 1.1%, 1.2%. W olff- P arkin son - W hite 3 0.14%. (1971) 0.14%, (1967) 0.21%. 4.7%, 2.6%. 1.2% 0.5%. 1.9%, 0.7%. Hiss (1962) 1.02% ( ). (1984) 1.4%, 0.7%

. (1971) 4.7%, 2.4%.. 0.6%, 0.4%. His s (1962) 0.11%. (1984) 0.3%, 0.4%. (1984) 30. (1971) 0.7%, 0.6%. 50.,, 3.2%, 1.7%. 1.4%, 0.4%. Hiss (1962) 0.004%. (1984) 1.8%, 1.2%. (1984). (1984) 30. (1971) 3.4%, 3.5%.,,,,,.. ( ). V. 20,. 20 2,083 ( ;721, ;1,362 ). 1996 10 1997 2,. 1. 33 1 52.8%, 43.7%. 17.6%, 15.4%.,,,, T ST. 2. 33, 128. (100.0% ) (95.7% ). left anterior fascicular block ( ; 73.9% ) T ( ; 67.1% ). 25 ( ; 14 ), ( ; 19 ). 3.,,

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