TY - JOUR
T1 - Global ECG measures and cardiac structure and function the ARIC study (Atherosclerosis risk in communities)
AU - Biering-Sørensen, Tor
AU - Kabir, Muammar
AU - Waks, Jonathan W.
AU - Thomas, Jason
AU - Post, Wendy S.
AU - Soliman, Elsayed Z.
AU - Buxton, Alfred E.
AU - Shah, Amil M.
AU - Solomon, Scott D.
AU - Tereshchenko, Larisa G.
N1 - Funding Information:
The ARIC study (Atherosclerosis Risk in Communities) has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services(under contract numbers: HHSN268201700001I, HHSN268201700003I, HHSN268201700005I, HHS-N268201700004I, and HHSN2682017000021). This work was supported by 1R01HL118277 (Dr Tereshchenko).
Publisher Copyright:
© 2018 American Heart Association, Inc.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - BACKGROUND: Electric excitation initiates myocardial mechanical contraction and coordinates myocardial pumping. We hypothesized that ECG global electric heterogeneity (GEH) and its longitudinal changes are associated with cardiac structure and function. METHODS AND RESULTS: Participants from the ARIC study (Atherosclerosis Risk in Communities) (N=5114; 58% female; 22% blacks) with resting 12-lead ECGs (visits 1–5) and echocardiographic assessment of left ventricular (LV) ejection fraction, LV global longitudinal strain, LV mass index, LV end-diastolic volume index, and LV end-systolic volume index at visit 5 were included. Longitudinal analysis included ARIC participants (N=14609) with measured GEH at visits 1 to 4. GEH was quantified by spatial ventricular gradient, QRS-T angle, and sum absolute QRS-T integral. Cross-sectional and longitudinal regressions were adjusted for manifest and subclinical cardiovascular disease. Having 4 abnormal GEH parameters was associated with a 6.4% (95% confidence interval, 5.5–7.3) LV ejection fraction decline, a 24.2 g/m 2 (95% confidence interval, 21.5–26.9) increase in LV mass index, a 10.3 mL/m 2 (95% confidence interval, 8.9–11.7) increase in LV end-diastolic volume index, and a 7.8 mL/m 2 (95% confidence interval, 6.9–8.6) increase in LV end-systolic volume index. Altogether, clinical and ECG parameters accounted for approximately one third of LV volume and 20% of systolic function variability. The associations were significantly stronger in cardiovascular disease. Sum absolute QRS-T integral increased by 20 mV*ms for each 3-year period in participants who demonstrated LV dilatation at visit 5. Sudden cardiac death victims demonstrated rapid GEH worsening, whereas those with LV dysfunction demonstrated slow GEH worsening. Healthy aging was associated with a distinct pattern of spatial ventricular gradient azimuth decrement. CONCLUSIONS: GEH is a marker of subclinical abnormalities in cardiac structure and function.
AB - BACKGROUND: Electric excitation initiates myocardial mechanical contraction and coordinates myocardial pumping. We hypothesized that ECG global electric heterogeneity (GEH) and its longitudinal changes are associated with cardiac structure and function. METHODS AND RESULTS: Participants from the ARIC study (Atherosclerosis Risk in Communities) (N=5114; 58% female; 22% blacks) with resting 12-lead ECGs (visits 1–5) and echocardiographic assessment of left ventricular (LV) ejection fraction, LV global longitudinal strain, LV mass index, LV end-diastolic volume index, and LV end-systolic volume index at visit 5 were included. Longitudinal analysis included ARIC participants (N=14609) with measured GEH at visits 1 to 4. GEH was quantified by spatial ventricular gradient, QRS-T angle, and sum absolute QRS-T integral. Cross-sectional and longitudinal regressions were adjusted for manifest and subclinical cardiovascular disease. Having 4 abnormal GEH parameters was associated with a 6.4% (95% confidence interval, 5.5–7.3) LV ejection fraction decline, a 24.2 g/m 2 (95% confidence interval, 21.5–26.9) increase in LV mass index, a 10.3 mL/m 2 (95% confidence interval, 8.9–11.7) increase in LV end-diastolic volume index, and a 7.8 mL/m 2 (95% confidence interval, 6.9–8.6) increase in LV end-systolic volume index. Altogether, clinical and ECG parameters accounted for approximately one third of LV volume and 20% of systolic function variability. The associations were significantly stronger in cardiovascular disease. Sum absolute QRS-T integral increased by 20 mV*ms for each 3-year period in participants who demonstrated LV dilatation at visit 5. Sudden cardiac death victims demonstrated rapid GEH worsening, whereas those with LV dysfunction demonstrated slow GEH worsening. Healthy aging was associated with a distinct pattern of spatial ventricular gradient azimuth decrement. CONCLUSIONS: GEH is a marker of subclinical abnormalities in cardiac structure and function.
KW - Atherosclerosis
KW - Dilatation
KW - Electrocardiography
KW - Hypertrophy, left ventricular
KW - Vectorcardiography
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U2 - 10.1161/CIRCEP.117.005961
DO - 10.1161/CIRCEP.117.005961
M3 - Article
C2 - 29496680
AN - SCOPUS:85053220558
SN - 1941-3149
VL - 11
JO - Circulation: Arrhythmia and Electrophysiology
JF - Circulation: Arrhythmia and Electrophysiology
IS - 3
M1 - e005961
ER -