{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T21:19:01Z","timestamp":1758403141410,"version":"3.41.2"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              A few studies have recently reported clockwise and counterclockwise rotations of\n              <jats:styled-content style=\"fixed-case\">QRS<\/jats:styled-content>\n              transition zone as predictors of mortality. However, their prospective correlates and associations with individual cardiovascular disease (\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              ) outcomes are yet to be investigated.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Among 13\u00a0567\n              <jats:styled-content style=\"fixed-case\">ARIC<\/jats:styled-content>\n              (Atherosclerosis Risk in Communities) study participants aged 45 to 64\u00a0years, we studied key correlates of changes in the status of clockwise and counterclockwise rotation over time as well as the association of rotation status with incidence of coronary heart disease (2408 events), heart failure (2196 events), stroke (991 events), composite\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              (4124 events), 898\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              deaths, and 3469 non\u2010\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              deaths over 23\u00a0years of follow\u2010up. At baseline, counterclockwise rotation was most prevalent (52.9%), followed by no (40.5%) and clockwise (6.6%) rotation. Of patients with no rotation, 57.9% experienced counterclockwise or clockwise rotation during follow\u2010up, with diabetes mellitus and black race significantly predicting clockwise and counterclockwise conversion, respectively. Clockwise rotation was significantly associated with higher risk of heart failure (hazard ratio, 1.20; 95% confidence interval [CI], 1.02\u20131.41) and non\u2010\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              death (hazard ratio, 1.28; 95% CI, 1.12\u20131.46) after adjusting for potential confounders including other ECG parameters. On the contrary, counterclockwise rotation was significantly related to lower risk of composite\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              (hazard ratio, 0.93; 95% CI, 0.87\u20130.99]),\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              mortality (hazard ratio, 0.76; 95% CI, 0.65\u20130.88), and non\u2010\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              deaths (hazard ratio, 0.92; 95% CI, 0.85\u20130.99 [borderline significance with heart failure]).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Counterclockwise rotation, the most prevalent\n              <jats:styled-content style=\"fixed-case\">QRS<\/jats:styled-content>\n              transition zone pattern, demonstrated the lowest risk of\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              and mortality, whereas clockwise rotation was associated with the highest risk of heart failure and non\u2010\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              mortality. These results have implications on how to interpret\n              <jats:styled-content style=\"fixed-case\">QRS<\/jats:styled-content>\n              transition zone rotation when ECG was recorded.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.117.006281","type":"journal-article","created":{"date-parts":[[2017,11,4]],"date-time":"2017-11-04T00:10:30Z","timestamp":1509754230000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Counterclockwise and Clockwise Rotation of QRS Transitional Zone: Prospective Correlates of Change and Time\u2010Varying Associations With Cardiovascular Outcomes"],"prefix":"10.1161","volume":"6","author":[{"given":"Siddharth","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Kwak","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunil K.","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Mount Sinai Health System, New York, NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Larisa G.","family":"Tereshchenko","sequence":"additional","affiliation":[{"name":"Knight Cardiovascular Institute, Oregon Health &amp; Science University, Portland, OR"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josef","family":"Coresh","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elsayed Z.","family":"Soliman","sequence":"additional","affiliation":[{"name":"Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston\u2010Salem, NC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kunihiro","family":"Matsushita","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2013.01.294"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2013.07.023"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.113.001396"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2012.06.060"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.070045"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euu149"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2014.08.014"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a115184"},{"key":"e_1_3_5_10_2","doi-asserted-by":"crossref","unstructured":"Prineas R Crow R Zhang Z. 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