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In this issue of the journal, Shoji et al showed that isolated non-specific ST-segment and T-wave abnormalities (NSSTTAs) are associated with incident heart failure (HF).1 The authors conducted a large prospective general population cohort study of more than 30 000 African-American and white participants aged ≥45 years, with more than 13 years of follow-up. Incident HF events were rigorously adjudicated and classified based on left ventricular ejection fraction (LVEF) measurement at or near the time of incident HF as HF with reduced ejection fraction (HFrEF; LVEF <50%) or HF with preserved ejection fraction (HFpEF; LVEF ≥50%). Cause-specific Cox regression models were adjusted for known HF risk factors, statin use and time-updated incident coronary heart disease (CHD) events. Remarkably, after adjustment, the presence of isolated NSSTTAs indicated a more than doubled risk of HFrEF and a 66% increased risk of HFpEF.1